Active NPI
Theresa Rodeghero, DMD
- Dentist
- Clearwater, FL
National Provider Identifier
1205611670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN28481
- Practice address
- 215 S Myrtle Ave
Clearwater, FL 33756-5521 - Phone
- (727) 442-3363
- NPI assigned
- Aug 25, 2023
- Last updated
- Aug 25, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN28481 | FL | Primary |
Addresses
Primary practice location
215 S Myrtle Ave
Clearwater, FL 33756-5521
Mailing address
215 S Myrtle Ave
Clearwater, FL 33756-5521
Phone (727) 442-3363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 28, 2025 through Mar 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN28481 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692921600000",
"number": "1205611670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 S MYRTLE AVE",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337565521",
"telephone_number": "727-442-3363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S MYRTLE AVE",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337565521",
"telephone_number": "727-442-3363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODEGHERO",
"first_name": "THERESA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-25",
"last_updated": "2023-08-25",
"certification_date": "2023-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN28481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearwater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.