Healthcare Provider Details

I. General information

NPI: 1598685711
Provider Name (Legal Business Name): THELMA XISTO GOMES PEDRO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17011 MIRAMAR PKWY
MIRAMAR FL
33027-4564
US

IV. Provider business mailing address

928 OPAL TER # WESTON
WESTON FL
33326-3905
US

V. Phone/Fax

Practice location:
  • Phone: 954-504-9167
  • Fax:
Mailing address:
  • Phone: 407-346-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: