MEDICARE: SASHA PUJADAS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN28798	FL

General Provider Information

NPI Number	:	1225723612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA PUJADAS DMD

Provider Business Mailing Address
First Line	:	103 FAIRMOUNT BEACH CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	727-604-9022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	03/10/2025

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