Healthcare Provider Details

I. General information

NPI: 1730244948
Provider Name (Legal Business Name): ALY HANY MORSHED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 E 15TH ST
PANAMA CITY FL
32404-5831
US

IV. Provider business mailing address

3518 E 15TH ST
PANAMA CITY FL
32404-5831
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-4455
  • Fax: 850-747-5660
Mailing address:
  • Phone: 850-872-4455
  • Fax: 850-747-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6513
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08391
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN18413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: