=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891812632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY GULDE DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 11/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15820 DORA AVE
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-4969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-602-4235
-----------------------------------------------------
Fax | 352-602-4347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15820 DORA AVE SUITE A
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-4969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-602-4235
-----------------------------------------------------
Fax | 352-602-4347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY J. GULDE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 352-602-4235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN15562
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------