Healthcare Provider Details

I. General information

NPI: 1376462077
Provider Name (Legal Business Name): TRANSFORMATION DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW 76TH DR STE A
GAINESVILLE FL
32607-6671
US

IV. Provider business mailing address

220 NW 76TH DR STE A
GAINESVILLE FL
32607-6671
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-4080
  • Fax: 352-332-6694
Mailing address:
  • Phone: 352-331-4080
  • Fax: 352-332-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARY E MIDDLETON
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-331-4080