Healthcare Provider Details

I. General information

NPI: 1225199235
Provider Name (Legal Business Name): ANDONIS TEREZIDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

10428 STAPELEY DR
ORLANDO FL
32832-6952
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-3000
  • Fax:
Mailing address:
  • Phone: 407-553-2894
  • Fax: 407-553-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN 17898
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: