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NPI 1265546311

NPI 1265546311 : ARUNA AVANTI : JACKSONVILLE, FL

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General NPI Number Information
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    NPI Number           |    1265546311
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    Entity Type          |    Individual 
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    Provider Name        |    ARUNA AVANTI
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/18/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    10950-64 SAN JOSE BLVD 
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    City                 |    JACKSONVILLE
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    State                |    FL
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    Zip                  |    32223
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    Country              |    US
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    Telephone            |    904-260-4244
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2502 N ROCKY POINT DR SUITE 1000 - CREDENTIALING
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    City                 |    TAMPA
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    State                |    FL
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    Zip                  |    33607-1421
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    Country              |    US
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    Telephone            |    
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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        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    DN17406
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    License Number State |    FL
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