Provider Demographics
NPI:1457581274
Name:PIEDRA, CARLOS AURELIO (DMD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:AURELIO
Last Name:PIEDRA
Suffix:
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 1:2315 NW 52ND PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6245
Mailing Address - Country:US
Mailing Address - Phone:352-378-1700
Mailing Address - Fax:
Practice Address - Street 1:3909 W NEWBERRY RD STE G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2367
Practice Address - Country:US
Practice Address - Phone:352-371-9831
Practice Address - Fax:352-336-8563
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice