Healthcare Provider Details

I. General information

NPI: 1568781227
Provider Name (Legal Business Name): JUGNU DHAMIJA D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 ALOMA AVE
WINTER PARK FL
32792-3701
US

IV. Provider business mailing address

3011 ALOMA AVE
WINTER PARK FL
32792-3701
US

V. Phone/Fax

Practice location:
  • Phone: 321-246-6027
  • Fax:
Mailing address:
  • Phone: 321-246-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN15961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 15961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: