Healthcare Provider Details

I. General information

NPI: 1265231716
Provider Name (Legal Business Name): NOOR SUFYAN HAMMAD ALRAWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 BLUEBIRD DR
TAMPA FL
33647-2827
US

IV. Provider business mailing address

9421 BLUEBIRD DR
TAMPA FL
33647-2827
US

V. Phone/Fax

Practice location:
  • Phone: 813-753-1153
  • Fax:
Mailing address:
  • Phone: 813-753-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: