Healthcare Provider Details

I. General information

NPI: 1306546148
Provider Name (Legal Business Name): DARA ALVAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N NORTH DR
SIOUX FALLS SD
57104-0915
US

IV. Provider business mailing address

1715 N WEST SHORE BLVD
TAMPA FL
33607-3925
US

V. Phone/Fax

Practice location:
  • Phone: 605-367-5051
  • Fax:
Mailing address:
  • Phone: 813-822-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1476
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: