Active NPI
Mateo Vidales, DMD
- Dentist
- Davenport, FL
National Provider Identifier
1871086405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 23425
- Practice address
- 7700 Lake Wilson Rd
Davenport, FL 33896-9601 - Phone
- (863) 420-3166
- NPI assigned
- Jun 8, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 23425 | FL | Primary |
Addresses
Primary practice location
7700 Lake Wilson Rd
Davenport, FL 33896-9601
Mailing address
1640 Wise Dr
North Port, FL 34286-6830
Phone (941) 408-6601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23425 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TP Bay Smiles | Current | Accepting new patients | |
| Vidales Dental Corp | Dentist | Current | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Tampa, FL
- NPI 1447942131
-
- Dentist
- Lakeland, FL
- NPI 1780466011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528416000000",
"number": "1871086405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 WISE DR",
"city": "NORTH PORT",
"state": "FL",
"postal_code": "342866830",
"telephone_number": "941-408-6601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7700 LAKE WILSON RD",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338969601",
"telephone_number": "863-420-3166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDALES",
"first_name": "MATEO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-08",
"last_updated": "2018-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "23425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.