Healthcare Provider Details

I. General information

NPI: 1629616081
Provider Name (Legal Business Name): ESHA PERSAD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 MAIN ST
DUNEDIN FL
34698-6242
US

IV. Provider business mailing address

1636 38TH AVE N
ST PETERSBURG FL
33713-1920
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-8478
  • Fax:
Mailing address:
  • Phone: 720-725-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: