Healthcare Provider Details

I. General information

NPI: 1275764029
Provider Name (Legal Business Name): DOMINICK CATANIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD D4-4
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

5101E BUSCH BLVD 13
TAMPA FL
33617-5380
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5801
  • Fax: 352-392-3070
Mailing address:
  • Phone: 813-988-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN 18732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: