Provider Demographics
NPI:1346349461
Name:PICHARDO, EDGAR L (DMD)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:L
Last Name:PICHARDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 HWY 44 W
Mailing Address - Street 2:UNIT 101
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453
Mailing Address - Country:US
Mailing Address - Phone:362-726-5854
Mailing Address - Fax:352-726-6893
Practice Address - Street 1:2231 HWY 44
Practice Address - Street 2:UNIT 101
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453
Practice Address - Country:US
Practice Address - Phone:352-726-5854
Practice Address - Fax:352-726-6893
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16047122300000X
FL16047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist