Provider Demographics
NPI:1427397058
Name:FREDERICO TEPEDINO DMD PA
Entity Type:Organization
Organization Name:FREDERICO TEPEDINO DMD PA
Other - Org Name:DENTAL ARTS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPEDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-998-9820
Mailing Address - Street 1:7645 GATE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2889
Mailing Address - Country:US
Mailing Address - Phone:904-998-9820
Mailing Address - Fax:904-998-6650
Practice Address - Street 1:7645 GATE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2889
Practice Address - Country:US
Practice Address - Phone:904-998-9820
Practice Address - Fax:904-998-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN1886591223E0200X
FLDN188761223G0001X
FLDN179361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty