Healthcare Provider Details

I. General information

NPI: 1235264060
Provider Name (Legal Business Name): EVELYN MIRANDA HALEM, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S HIAWASSEE RD STE C
ORLANDO FL
32835-5786
US

IV. Provider business mailing address

1405 S HIAWASSEE RD STE C
ORLANDO FL
32835-5786
US

V. Phone/Fax

Practice location:
  • Phone: 407-294-6009
  • Fax: 407-294-2722
Mailing address:
  • Phone: 407-294-6009
  • Fax: 407-294-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13516
License Number StateFL

VIII. Authorized Official

Name: DR. EVELYN MIRANDA HALEM
Title or Position: PRESIDENT
Credential:
Phone: 407-294-6009