Healthcare Provider Details

I. General information

NPI: 1316333230
Provider Name (Legal Business Name): REHAN GHANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLORIDA AVE STE 6
LAKELAND FL
33801-5237
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax: 863-616-9709
Mailing address:
  • Phone: 866-234-8534
  • Fax: 863-837-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN21103
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: