Individual
RODOLFO TEJADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2435 S VOLUSIA AVE STE D2, ORANGE CITY, FL 32763-7643
(386) 878-4395
Mailing address
10452 PROVENCE DR, ORLANDO, FL 32836-8873
(860) 919-2104
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN20826
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023632900
—
FL
Enumeration date
07/04/2011
Last updated
07/01/2019
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