Healthcare Provider Details

I. General information

NPI: 1073477121
Provider Name (Legal Business Name): SP DENTAL & AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CASA MIRELLA WAY APT 2207
WINDERMERE FL
34786-7859
US

IV. Provider business mailing address

123 CASA MIRELLA WAY APT 2207
WINDERMERE FL
34786-7859
US

V. Phone/Fax

Practice location:
  • Phone: 786-442-9993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER PARDO
Title or Position: DENTIST
Credential: DMD
Phone: 786-442-9993