Healthcare Provider Details

I. General information

NPI: 1730960634
Provider Name (Legal Business Name): MOHAMAD BADRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27417 US HIGHWAY 27
LEESBURG FL
34748-9084
US

IV. Provider business mailing address

240 S 40TH ST
PHILADELPHIA PA
19104-6030
US

V. Phone/Fax

Practice location:
  • Phone: 352-453-8368
  • Fax:
Mailing address:
  • Phone: 215-573-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: