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General NPI Number Information
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NPI Number | 1316487531
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Entity Type | Individual
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Provider Name | ISIS EL GHANNAM DDS
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Gender | Female
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 24795 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33559-6243
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Country | US
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Telephone | 813-733-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 24795 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33559-6243
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Country | US
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Telephone | 786-716-1589
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN24480
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License Number State | FL
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