Healthcare Provider Details

I. General information

NPI: 1689716094
Provider Name (Legal Business Name): DAVID ARTEAGA MD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 BEDFORD DRIVE
MELBOURNE FL
32940
US

IV. Provider business mailing address

1371 BEDFORD DRIVE
MELBOURNE FL
32940
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-2100
  • Fax: 321-242-6626
Mailing address:
  • Phone: 321-242-2100
  • Fax: 321-242-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN10433
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME57190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: