Provider Demographics
NPI:1992086771
Name:PRENDIVILLE, MARY TERESA GUNNING (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY TERESA
Middle Name:GUNNING
Last Name:PRENDIVILLE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 PLANTATION CIR APT 305
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-1508
Mailing Address - Country:US
Mailing Address - Phone:305-972-4887
Mailing Address - Fax:
Practice Address - Street 1:1495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5202
Practice Address - Country:US
Practice Address - Phone:863-533-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN209021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program