Healthcare Provider Details

I. General information

NPI: 1912759911
Provider Name (Legal Business Name): PEYMAN TADI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 BELCHER RD S
LARGO FL
33771-5243
US

IV. Provider business mailing address

1475 S BELCHER RD
CLEARWATER FL
33764-2829
US

V. Phone/Fax

Practice location:
  • Phone: 727-472-2820
  • Fax:
Mailing address:
  • Phone: 727-472-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number064664
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: