Healthcare Provider Details

I. General information

NPI: 1265838494
Provider Name (Legal Business Name): CAROLINA ESCOBEDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CARILLON PKWY STE 120
ST PETERSBURG FL
33716-1290
US

IV. Provider business mailing address

400 CARILLON PKWY
ST PETERSBURG FL
33716-1290
US

V. Phone/Fax

Practice location:
  • Phone: 727-299-0728
  • Fax: 727-209-1365
Mailing address:
  • Phone: 727-299-0728
  • Fax: 727-209-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19517
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number057733-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN195517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: