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General NPI Number Information
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NPI Number | 1336941491
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Entity Type | Organization
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Legal Business Name | BRKN DENTAL PLLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 4151 HUNTERS PARK LN STE 124
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City | ORLANDO
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State | FL
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Zip | 32837-3617
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Country | US
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Telephone | 407-859-1418
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Fax |
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Provider Business Mailing Address
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Address Line | 4151 HUNTERS PARK LN STE 124
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City | ORLANDO
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State | FL
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Zip | 32837-3617
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Country | US
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Telephone | 407-859-1418
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. MONA KHALAJ
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Credential | DMD
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Telephone | 408-202-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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