Provider Demographics
NPI:1497752315
Name:CARDOZO, REGINALD HORACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:HORACE
Last Name:CARDOZO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:PROF
Other - First Name:REGINALD
Other - Middle Name:H
Other - Last Name:CARDOZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PA
Mailing Address - Street 1:7301A W PALMETTO PARK RD
Mailing Address - Street 2:#203-A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3409
Mailing Address - Country:US
Mailing Address - Phone:561-362-8308
Mailing Address - Fax:561-362-7654
Practice Address - Street 1:7301A W PALMETTO PARK RD
Practice Address - Street 2:#203-A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3409
Practice Address - Country:US
Practice Address - Phone:561-362-8308
Practice Address - Fax:561-362-7654
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00135821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice