Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DTP568 | FL |
N | 1223P0221X | Pediatric Dentist | 136-000255 | IL |
NPI | 1043585706 |
---|---|
Provider Name | Leda Regina Fernandes Mugayar |
First Address | Chicago, IL 60612-7210 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2012 |
Last Update Date | 30/07/2020 |