Provider Demographics
NPI:1992872709
Name:GIRALDO, JOSE MAURICIO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MAURICIO
Last Name:GIRALDO
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 1:345 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2344
Mailing Address - Country:US
Mailing Address - Phone:813-662-9282
Mailing Address - Fax:813-662-9727
Practice Address - Street 1:1745 S KINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6220
Practice Address - Country:US
Practice Address - Phone:813-662-9282
Practice Address - Fax:813-662-9727
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist