Provider Demographics
NPI:1578721809
Name:ST MATTHEW-DANIELS, TEJUMADE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:TEJUMADE
Middle Name:
Last Name:ST MATTHEW-DANIELS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N KIRKMAN RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-1186
Mailing Address - Country:US
Mailing Address - Phone:407-290-9588
Mailing Address - Fax:407-292-6190
Practice Address - Street 1:217 N KIRKMAN RD
Practice Address - Street 2:SUITE #3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1186
Practice Address - Country:US
Practice Address - Phone:407-290-9588
Practice Address - Fax:407-292-6190
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice