Healthcare Provider Details

I. General information

NPI: 1982607974
Provider Name (Legal Business Name): DWIGHT H. PATE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 PILAKLAKAHA AVE STE A
AUBURNDALE FL
33823-3321
US

IV. Provider business mailing address

306 PILAKLAKAHA AVE STE A
AUBURNDALE FL
33823-3321
US

V. Phone/Fax

Practice location:
  • Phone: 863-967-1233
  • Fax: 863-967-7603
Mailing address:
  • Phone: 863-967-1233
  • Fax: 863-967-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 10592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: