Provider Demographics
NPI:1689716094
Name:ARTEAGA, DAVID (MD DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 BEDFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-242-2100
Mailing Address - Fax:321-242-6626
Practice Address - Street 1:1371 BEDFORD DRIVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-242-2100
Practice Address - Fax:321-242-6626
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10433204E00000X
FLME57190204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37614Medicare UPIN
FL11679Medicare ID - Type Unspecified