Healthcare Provider Details

I. General information

NPI: 1467753681
Provider Name (Legal Business Name): ANTHONY J. AULETTA, JR. D.M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8277 113TH STREET N
SEMINOLE FL
33772
US

IV. Provider business mailing address

8277 113TH ST
SEMINOLE FL
33772-4128
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-8500
  • Fax: 727-393-2977
Mailing address:
  • Phone: 727-397-8500
  • Fax: 727-393-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10436
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY JOSEPH AULETTA JR.
Title or Position: OWNER
Credential: D.M.D.
Phone: 727-397-8500