Healthcare Provider Details

I. General information

NPI: 1962102665
Provider Name (Legal Business Name): KARIM MEDHAT ABOUKOURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 SHANEWOOD CT
ORLANDO FL
32837-5121
US

IV. Provider business mailing address

4509 SHANEWOOD CT
ORLANDO FL
32837-5121
US

V. Phone/Fax

Practice location:
  • Phone: 407-454-4687
  • Fax:
Mailing address:
  • Phone: 407-454-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18563
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: