MEDICARE: PEARL VALLEY DENTAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295422194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL VALLEY DENTAL INC

Provider Business Mailing Address
First Line	:	11906 AUTUMN FERN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7230
Country	:	US
Telephone Number	:	254-913-1631
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 S JOHN YOUNG PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-7363
Country	:	US
Telephone Number	:	321-522-8577
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MUHAMMAD SHERYAR KHAN
Credential	:	DDS
Telephone Number	:	801-821-6945

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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Directions to “PEARL VALLEY DENTAL INC ” Practice Location

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