Healthcare Provider Details

I. General information

NPI: 1841754603
Provider Name (Legal Business Name): ALJONAIDY DENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W GRANADA BLVD STE 5
ORMOND BEACH FL
32174-5941
US

IV. Provider business mailing address

900 W GRANADA BLVD STE 5
ORMOND BEACH FL
32174-5941
US

V. Phone/Fax

Practice location:
  • Phone: 386-947-7603
  • Fax: 352-639-5688
Mailing address:
  • Phone: 386-947-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HUDA ALJONAIDY
Title or Position: OWNER
Credential:
Phone: 954-684-3432