=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407978075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUNJAN A. HARMANI D.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PALM COAST PKWY NE UNIT 606
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-8225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-446-5595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9971 VINEYARD LAKE RD E
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-371-8437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 24695
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------