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General NPI Number Information
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NPI Number | 1396133724
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Entity Type | Organization
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Legal Business Name | BEACON WOODS FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 12036 COBBLESTONE DR
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City | HUDSON
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State | FL
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Zip | 34667-2413
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Country | US
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Telephone | 727-862-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 12036 COBBLESTONE DR
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City | HUDSON
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State | FL
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Zip | 34667-2413
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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 | PRESIDENT
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Name | DR. ABDUL HAMEED KHAN
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Credential | D.D.S.
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Telephone | 727-364-5697
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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 | 9928
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License Number State | FL
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