Healthcare Provider Details

I. General information

NPI: 1336322650
Provider Name (Legal Business Name): RENATO J AVES JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 N ARMENIA AVE STE 200
TAMPA FL
33603-2603
US

IV. Provider business mailing address

7720 W WATERS AVE
TAMPA FL
33615-1813
US

V. Phone/Fax

Practice location:
  • Phone: 813-885-6555
  • Fax: 813-442-4691
Mailing address:
  • Phone: 813-426-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN 18163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: