Healthcare Provider Details

I. General information

NPI: 1770405730
Provider Name (Legal Business Name): PALM BREEZE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SAN FILIPPO DRIVE UNIT 104
PALM BAY FL
32909
US

IV. Provider business mailing address

7925 S TROPICAL TRL
MERRITT ISLAND FL
32952-6709
US

V. Phone/Fax

Practice location:
  • Phone: 321-447-4444
  • Fax:
Mailing address:
  • Phone: 321-536-0157
  • 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: MOHAMMED MUJEEB
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 321-447-4444