Provider Demographics
NPI:1669982773
Name:CAYCEDO, ANA MARIA (RDH)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:CAYCEDO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:971 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1205
Practice Address - Country:US
Practice Address - Phone:305-585-2826
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH20736124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist