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General NPI Number Information
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NPI Number | 1386934180
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Entity Type | Organization
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Legal Business Name | POINCIANA DENTAL
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 873 CYPRESS PKWY
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City | POINCIANA
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State | FL
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Zip | 34759-3408
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Country | US
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Telephone | 407-846-4775
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Fax | 407-846-8114
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Provider Business Mailing Address
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Address Line | 873 CYPRESS PKWY
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City | POINCIANA
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State | FL
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Zip | 34759-3408
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Country | US
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Telephone | 407-846-4775
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Fax | 407-846-8114
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Authorized Official
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Title or Position | DOCTOR
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Name | PEDRAM BEHNIA
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Credential | M.D
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Telephone | 407-846-4775
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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 | DN14171
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License Number State | FL
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