Provider Demographics
NPI:1962714857
Name:PAGIDIPATI, AMI (DMD)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:
Last Name:PAGIDIPATI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:450 KNIGHTS RUN AVE UNIT 1801
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5996
Mailing Address - Country:US
Mailing Address - Phone:813-340-1644
Mailing Address - Fax:
Practice Address - Street 1:8409 SW 80TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9117
Practice Address - Country:US
Practice Address - Phone:352-306-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 201031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics