Healthcare Provider Details

I. General information

NPI: 1912117441
Provider Name (Legal Business Name): DONALD ROSS TADDEO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 S ALAFAYA TRL
ORLANDO FL
32828-8956
US

IV. Provider business mailing address

1561 S ALAFAYA TRL
ORLANDO FL
32828-8956
US

V. Phone/Fax

Practice location:
  • Phone: 407-482-3700
  • Fax: 407-482-2004
Mailing address:
  • Phone: 407-482-3700
  • Fax: 407-482-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN0013377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: