Healthcare Provider Details

I. General information

NPI: 1164356507
Provider Name (Legal Business Name): NOOR ALAIN RAMZI MUTAWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 GREAT POND DR STE 1000
ALTAMONTE SPRINGS FL
32714-7244
US

IV. Provider business mailing address

4178 SHADOW CREEK CIR
OVIEDO FL
32765-7936
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-0444
  • Fax: 407-862-2771
Mailing address:
  • Phone: 407-738-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD31994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: