Provider Demographics
NPI:1376217422
Name:DUARTE, AUGUSTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:
Last Name:DUARTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 VISTA CRUISER LN
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5230
Mailing Address - Country:US
Mailing Address - Phone:786-675-7464
Mailing Address - Fax:
Practice Address - Street 1:3400 GULF TO BAY BLVD RM 2808
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4514
Practice Address - Country:US
Practice Address - Phone:786-675-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist