1497314454 NPI number — CHRISTINE MARIE TALEGAONKAR DMD, MD

Table of content: CHRISTINE MARIE TALEGAONKAR DMD, MD (NPI 1497314454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497314454 NPI number — CHRISTINE MARIE TALEGAONKAR DMD, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALEGAONKAR
Provider First Name:
CHRISTINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRAKA
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD, MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497314454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF FLORIDA ORAL AND MAXILLOFACIAL SURGERY
Provider Second Line Business Mailing Address:
1395 CENTER DRIVE
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-6746
Provider Business Mailing Address Fax Number:
352-392-7609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF FLORIDA ORAL AND MAXILLOFACIAL SURGERY
Provider Second Line Business Practice Location Address:
1395 CENTER DRIVE
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-6746
Provider Business Practice Location Address Fax Number:
352-392-7609
Provider Enumeration Date:
06/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DRPM2060 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111882000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com