Provider Demographics
NPI:1184065294
Name:VIDICAN, CLEO BIANCA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLEO
Middle Name:BIANCA
Last Name:VIDICAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CLIO
Other - Middle Name:
Other - Last Name:VIDICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 100414
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0414
Mailing Address - Country:US
Mailing Address - Phone:352-273-6695
Mailing Address - Fax:352-294-5310
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5564
Practice Address - Country:US
Practice Address - Phone:352-273-6695
Practice Address - Fax:352-294-5310
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT257801223X0008X, 122300000X
FLDN235031223X0008X
MND132611223X0008X, 122300000X
TN118481223X0008X, 122300000X
MI29016007901223X0008X, 122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No122300000XDental ProvidersDentist