Healthcare Provider Details

I. General information

NPI: 1821729799
Provider Name (Legal Business Name): IRINY GADOON TADROS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15148 N DALE MABRY HWY
TAMPA FL
33618-1817
US

IV. Provider business mailing address

17358 OLD TOBACCO RD
LUTZ FL
33558-4955
US

V. Phone/Fax

Practice location:
  • Phone: 630-923-1708
  • Fax:
Mailing address:
  • Phone: 630-923-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033692
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: