Healthcare Provider Details

I. General information

NPI: 1104766914
Provider Name (Legal Business Name): ROYARABB PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

1770 S HABANA AVE
TAMPA FL
33629-6124
US

V. Phone/Fax

Practice location:
  • Phone: 407-738-1332
  • Fax:
Mailing address:
  • Phone: 407-738-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROYA RABBANIFARD
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 407-738-1332