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General NPI Number Information
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NPI Number | 1346017514
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Entity Type | Individual
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Provider Name | HETIENNE MOTA MACEDO DDS
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Gender | Female
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 690 GOODLETTE-FRANK RD N
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City | NAPLES
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State | FL
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Zip | 34102-5613
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Country | US
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Telephone | 239-263-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 26 LE MARC CT
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City | ROCHESTER
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State | NY
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Zip | 14618-5657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28713
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28713
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License Number State | FL
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