Provider Demographics
NPI:1780083501
Name:JUAN F. PRADO D.D.S. P.A.
Entity type:Organization
Organization Name:JUAN F. PRADO D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-968-1373
Mailing Address - Street 1:13301 N DALE MABRY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2400
Mailing Address - Country:US
Mailing Address - Phone:813-968-1373
Mailing Address - Fax:813-960-3560
Practice Address - Street 1:13301 N DALE MABRY HWY STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2400
Practice Address - Country:US
Practice Address - Phone:813-968-1373
Practice Address - Fax:813-960-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20896305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization