Provider Demographics
NPI:1750331849
Name:POPA, CYNTHIA J (DDS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:POPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:352-742-3264
Practice Address - Street 1:212 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3808
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:352-742-3264
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13779122300000X
OH30-01-85411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001848700Medicaid
OH0788045Medicaid