Healthcare Provider Details

I. General information

NPI: 1770751539
Provider Name (Legal Business Name): EDUARDO PRADO I D.D.S,M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDUARDO PRADO D.D.S.,.M.S.D.

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 US HIGHWAY 1 SUITE 10
NORTH PALM BEACH FL
33408-4415
US

IV. Provider business mailing address

PO BOX 13089
NORTH PALM BEACH FL
33408-7089
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8180
  • Fax:
Mailing address:
  • Phone: 561-630-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: