MEDICARE: PERDIDO DENTAL ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN10124	FL

General Provider Information

NPI Number	:	1407978851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERDIDO DENTAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	12385 SORRENTO RD
Second Line	:	SUITE A-1
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8664
Country	:	US
Telephone Number	:	850-492-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	12385 SORRENTO RD
Second Line	:	SUITE A-1
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8664
Country	:	US
Telephone Number	:	850-492-0433
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. L. MICHAEL PAPADELIAS
Credential	:	D.M.D.
Telephone Number	:	850-492-0433

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	08/22/2020

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