Provider Demographics
NPI:1346654100
Name:GOTTARDI, DAVIDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVIDE
Middle Name:
Last Name:GOTTARDI
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 1:10621 N KENDALL DR
Mailing Address - Street 2:#114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8708
Mailing Address - Country:US
Mailing Address - Phone:305-595-1131
Mailing Address - Fax:305-595-1143
Practice Address - Street 1:1045 KANE CONCOURSE
Practice Address - Street 2:#204
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2119
Practice Address - Country:US
Practice Address - Phone:305-868-4600
Practice Address - Fax:305-868-6994
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist