Healthcare Provider Details

I. General information

NPI: 1437780301
Provider Name (Legal Business Name): MORIO YOSHIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-19
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

PO BOX 100434
GAINESVILLE FL
32610-0434
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7846
  • Fax: 352-273-7848
Mailing address:
  • Phone: 352-273-7846
  • Fax: 352-273-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDRPM2092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: