Provider Demographics
NPI:1548678998
Name:ARRUDA, MOEMA (DMD)
Entity type:Individual
Prefix:MRS
First Name:MOEMA
Middle Name:
Last Name:ARRUDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4769 THE GROVE DR
Mailing Address - Street 2:#118
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786
Mailing Address - Country:US
Mailing Address - Phone:407-270-3997
Mailing Address - Fax:407-898-5576
Practice Address - Street 1:4769 THE GROVE DRIVE
Practice Address - Street 2:#118
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786
Practice Address - Country:US
Practice Address - Phone:407-270-3997
Practice Address - Fax:407-898-5576
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 207591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014094500Medicaid