Healthcare Provider Details

I. General information

NPI: 1992543961
Provider Name (Legal Business Name): MARIA AL CHAMMAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 WELLS RD STE 16
ORANGE PARK FL
32073-1723
US

IV. Provider business mailing address

600 TECHNOLOGY PARK STE 101
LAKE MARY FL
32746-7122
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-0140
  • Fax:
Mailing address:
  • Phone: 407-543-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: