Provider Demographics
NPI:1497497853
Name:LEAL, ELDREY RODRIGUES
Entity Type:Individual
Prefix:
First Name:ELDREY
Middle Name:RODRIGUES
Last Name:LEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WINDMEADOWS BLVD APT K114
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0428
Mailing Address - Country:US
Mailing Address - Phone:352-871-6849
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D2-27
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUFID56587350OtherUNIVERSITY OF FLORIDA, COLLEGE OF DENTISTRY