Provider Demographics
NPI:1215141494
Name:ACEVEDO, SONIA (RDH)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:BRINGUIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:10017 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5047
Mailing Address - Country:US
Mailing Address - Phone:813-972-7511
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH10354124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist