Provider Demographics
NPI:1972959195
Name:TADEU SZPOGANICZ, DMD, PA
Entity type:Organization
Organization Name:TADEU SZPOGANICZ, DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TADEU
Authorized Official - Middle Name:
Authorized Official - Last Name:SZPOGANICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-345-5200
Mailing Address - Street 1:7305 W SAMPLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2200
Mailing Address - Country:US
Mailing Address - Phone:954-345-5200
Mailing Address - Fax:
Practice Address - Street 1:7305 W SAMPLE RD STE 103
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2200
Practice Address - Country:US
Practice Address - Phone:954-345-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty