Provider Demographics
NPI:1265014310
Name:MEDINA SUAREZ, TAILYN (DMD)
Entity type:Individual
Prefix:
First Name:TAILYN
Middle Name:
Last Name:MEDINA SUAREZ
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 1:1093 CALLE 15
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5319
Mailing Address - Country:US
Mailing Address - Phone:512-662-6063
Mailing Address - Fax:
Practice Address - Street 1:HAMLIN PEDIATRIC DENTISTRY
Practice Address - Street 2:15415 WATERBIRD RD SUITE 100A
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-395-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0438931223G0001X
390200000X
FL263031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program