Healthcare Provider Details

I. General information

NPI: 1134052699
Provider Name (Legal Business Name): CARLA AL-KHOURI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 S DALE MABRY HWY STE C
TAMPA FL
33629-6322
US

IV. Provider business mailing address

1602 COUNTRY TRAILS DR
SAFETY HARBOR FL
34695-2065
US

V. Phone/Fax

Practice location:
  • Phone: 813-254-6838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: