Provider Demographics
NPI:1750877114
Name:BESADA, NATALIA (DMD, MS)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:BESADA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 N 36TH CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2226
Mailing Address - Country:US
Mailing Address - Phone:954-646-1978
Mailing Address - Fax:
Practice Address - Street 1:4730 W STATE ROAD 46 STE 1220
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9343
Practice Address - Country:US
Practice Address - Phone:407-708-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23365122300000X
390200000X
FLDN233651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151199OtherDENTAL INTERN PERMIT