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General NPI Number Information
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NPI Number | 1043182835
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Entity Type | Individual
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Provider Name | AYHAM AL MOMANI RDH
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Gender | Male
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 3436 S FLORIDA AVE STE 100
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City | LAKELAND
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State | FL
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Zip | 33803-4765
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Country | US
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Telephone | 863-607-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 13245 LONGACRE DR
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City | WINDERMERE
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State | FL
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Zip | 34786-6520
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Country | US
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Telephone | 689-286-8258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH31701
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License Number State | FL
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