Healthcare Provider Details

I. General information

NPI: 1699379545
Provider Name (Legal Business Name): IMAN TUNALI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 S US HIGHWAY 17/92 STE 221
CASSELBERRY FL
32707-2916
US

IV. Provider business mailing address

2514 TWILIGHT DR
ORLANDO FL
32825-7414
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-2255
  • Fax:
Mailing address:
  • Phone: 407-655-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH24870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: