Provider Demographics
NPI:1700271079
Name:FLEETWOOD, NADIA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:L
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NADIA
Other - Middle Name:L
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 E CENTRAL BLVD # 677
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1923
Mailing Address - Country:US
Mailing Address - Phone:774-316-6527
Mailing Address - Fax:
Practice Address - Street 1:13640 W COLONIAL DR # 180-190
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3992
Practice Address - Country:US
Practice Address - Phone:407-654-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 223491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019627100Medicaid