Healthcare Provider Details

I. General information

NPI: 1336941491
Provider Name (Legal Business Name): BRKN DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 HUNTERS PARK LN STE 124
ORLANDO FL
32837-3617
US

IV. Provider business mailing address

4151 HUNTERS PARK LN STE 124
ORLANDO FL
32837-3617
US

V. Phone/Fax

Practice location:
  • Phone: 407-859-1418
  • Fax:
Mailing address:
  • Phone: 407-859-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MONA KHALAJ
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 408-202-1013