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General NPI Number Information
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NPI Number | 1427397058
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Entity Type | Organization
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Legal Business Name | FREDERICO TEPEDINO DMD PA
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 7645 GATE PKWY SUITE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2889
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Country | US
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Telephone | 904-998-9820
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Fax | 904-998-6650
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Provider Business Mailing Address
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Address Line | 7645 GATE PKWY SUITE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2889
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Country | US
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Telephone | 904-998-9820
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Fax | 904-998-6650
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Authorized Official
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Title or Position | DENTIST
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Name | FREDERICO TEPEDINO
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Credential |
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Telephone | 904-998-9820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN188659
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN17936
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18876
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License Number State | FL
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