Provider Demographics
NPI:1346654100
Name:GOTTARDI, DAVIDE (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVIDE
Middle Name:
Last Name:GOTTARDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 N ANDREWS AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2566
Mailing Address - Country:US
Mailing Address - Phone:954-567-3311
Mailing Address - Fax:954-567-3361
Practice Address - Street 1:2654 N ANDREWS AVE STE 4
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-2566
Practice Address - Country:US
Practice Address - Phone:954-567-3311
Practice Address - Fax:954-567-3361
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20681122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist