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General NPI Number Information
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NPI Number | 1063420347
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL CLINIC PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 311 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-914-0550
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Fax | 850-914-8511
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Provider Business Mailing Address
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Address Line | 311 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-914-0550
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Fax | 850-914-8511
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. TAREK H ELZAWAHRY
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Credential | DMD
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Telephone | 850-914-0550
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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 | DN14287
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License Number State | FL
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