Healthcare Provider Details

I. General information

NPI: 1205865011
Provider Name (Legal Business Name): OSSAMA JUREYDA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17427 BRIDGE HILL CT SUITE A
TAMPA FL
33647-3679
US

IV. Provider business mailing address

10557 CORY LAKE DR
TAMPA FL
33647-2711
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-8999
  • Fax: 813-972-1666
Mailing address:
  • Phone: 716-472-7823
  • Fax: 813-986-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN17377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: