Provider Demographics
NPI:1598899221
Name:MEDVESKY, CAROLE ANN (DMD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:MEDVESKY
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 1:2329 SUNSET POINT RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1455
Mailing Address - Country:US
Mailing Address - Phone:727-799-3815
Mailing Address - Fax:727-797-4860
Practice Address - Street 1:2329 SUNSET POINT RD
Practice Address - Street 2:STE 202
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1455
Practice Address - Country:US
Practice Address - Phone:727-799-3815
Practice Address - Fax:727-797-4860
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice