Healthcare Provider Details

I. General information

NPI: 1184785503
Provider Name (Legal Business Name): MAJID HEYDARI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HEALD WAY #218
THE VILLAGES FL
32163-6087
US

IV. Provider business mailing address

340 HEALD WAY #218
THE VILLAGES FL
32163-6087
US

V. Phone/Fax

Practice location:
  • Phone: 352-633-2467
  • Fax:
Mailing address:
  • Phone: 352-633-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number053246-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: