Provider Demographics
NPI:1346450228
Name:RITA M MEDWID, D.D.S.,P.A.
Entity Type:Organization
Organization Name:RITA M MEDWID, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDWID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-287-2338
Mailing Address - Street 1:725 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2318
Mailing Address - Country:US
Mailing Address - Phone:772-287-2338
Mailing Address - Fax:
Practice Address - Street 1:725 SE OSCEOLA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2318
Practice Address - Country:US
Practice Address - Phone:772-287-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty