MEDICARE: ROPAFADZO GRACE MATANGIRA DDS

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	DN28953	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	13396	CT
3	1223G0001X	General Practice Dentistry	DN123235	GA

General Provider Information

NPI Number	:	1598400038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROPAFADZO GRACE MATANGIRA DDS

Provider Business Mailing Address
First Line	:	201 4TH ST S UNIT 806
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4587
Country	:	US
Telephone Number	:	980-254-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	3338 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-1846
Country	:	US
Telephone Number	:	727-359-0371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2022
Last Update Date	:	01/27/2025

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