Provider Demographics
NPI:1306196829
Name:TANGO DENTAL PA
Entity Type:Organization
Organization Name:TANGO DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:SCHMID HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-733-9911
Mailing Address - Street 1:3015 BAYVIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1710
Mailing Address - Country:US
Mailing Address - Phone:954-563-9722
Mailing Address - Fax:954-563-1912
Practice Address - Street 1:3015 BAYVIEW DR STE A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1710
Practice Address - Country:US
Practice Address - Phone:954-563-9722
Practice Address - Fax:954-563-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18919261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental