Provider Demographics
NPI:1265411953
Name:DOS PASSOS, JOHN DAVID II (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:DOS PASSOS
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 TUGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4878
Mailing Address - Country:US
Mailing Address - Phone:813-416-3022
Mailing Address - Fax:
Practice Address - Street 1:2114 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4704
Practice Address - Country:US
Practice Address - Phone:813-793-7976
Practice Address - Fax:813-574-6139
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN126801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073589200Medicaid