Healthcare Provider Details

I. General information

NPI: 1881901999
Provider Name (Legal Business Name): EVELYN MIRANDA HALEM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
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 NumberDN0013516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: