Healthcare Provider Details

I. General information

NPI: 1407854847
Provider Name (Legal Business Name): CATALIN TEODORU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 W BROAD ST
GROVELAND FL
34736-2012
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 352-429-1257
Mailing address:
  • Phone: 407-905-8827
  • Fax: 352-429-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16458
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN16458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: