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General NPI Number Information
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NPI Number | 1063191971
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Entity Type | Individual
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Provider Name | MEYZGAN AMIN
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 415 SUMMERHAVEN DR
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City | DEBARY
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State | FL
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Zip | 32713-2716
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Country | US
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Telephone | 312-478-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 1564 PEACE LILY WAY
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City | OVIEDO
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State | FL
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Zip | 32765-2014
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Country | US
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Telephone | 312-478-5729
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28204
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License Number State | FL
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