Provider Demographics
NPI:1841529583
Name:TEPEDINO, FREDERICO (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICO
Middle Name:
Last Name:TEPEDINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 GATE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2889
Mailing Address - Country:US
Mailing Address - Phone:904-998-9820
Mailing Address - Fax:904-998-6650
Practice Address - Street 1:7645 GATE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2889
Practice Address - Country:US
Practice Address - Phone:904-998-9820
Practice Address - Fax:904-998-6650
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice