Provider Demographics
NPI:1114024502
Name:FRANCISCO, EDGARD (DDS)
Entity type:Individual
Prefix:DR
First Name:EDGARD
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ED
Other - Middle Name:TONY
Other - Last Name:FRANCISCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2210 S MACDILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5917
Mailing Address - Country:US
Mailing Address - Phone:813-251-4432
Mailing Address - Fax:813-259-9443
Practice Address - Street 1:2210 S MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5917
Practice Address - Country:US
Practice Address - Phone:813-251-4432
Practice Address - Fax:813-259-9443
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist