Provider Demographics
NPI:1700232535
Name:PATALINGHUG, LADY JOEDELINE RAE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:LADY JOEDELINE RAE
Middle Name:
Last Name:PATALINGHUG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LADY JOEDELINE RAE
Other - Middle Name:
Other - Last Name:NEPOMUCENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:808-725-7963
Mailing Address - Fax:813-866-0930
Practice Address - Street 1:302 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3415
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-549-7855
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1514122300000X
FLDN234471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist