MEDICARE: DR. DAHOOD QAISI DMD

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	122300000X	Dentist	DN29158	FL

General Provider Information

NPI Number	:	1396580387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAHOOD QAISI DMD

Provider Business Mailing Address
First Line	:	426 CITI CTR ST BAY R-10
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 CITI CTR ST BAY R-10
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3425
Country	:	US
Telephone Number	:	863-533-6414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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