Anthony Tawadrous

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27216 Issued in FL

Practice address

1515 S Nova Rd
Daytona Beach, FL 32114-5815

Phone

(386) 947-9318

NPI assigned

Apr 7, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smile City Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Rockledge, FL
  • NPI 1508667981
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1376285742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2833 BELLWIND CIR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329555195",
            "telephone_number": "321-368-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S NOVA RD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145815",
            "telephone_number": "386-947-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAWADROUS",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-07",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "27216",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "27216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hamza Tariq
• Omaid Tariq
• Wendy Tavadia
• Danyetta Tavares, OWNER
• Peter Gene Taves, M.D.
• Taylor Hoeffert DC LLC
• Ajhiiyah Taylor
• Cheryl Lynn Taylor, EDD
• Jay Patrick Taylor, MD
• Mathew Dale Taylor, PA

• Pediatric Dentistry in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.