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General NPI Number Information
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NPI Number | 1447796859
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Entity Type | Organization
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Legal Business Name | DASANI DENTAL PA
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 6651 WOOLBRIGHT RD UNIT 116
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-0916
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Country | US
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Telephone | 352-328-5842
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Fax |
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Provider Business Mailing Address
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Address Line | 6651 WOOLBRIGHT RD UNIT 116
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-0916
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Country | US
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Telephone | 352-328-5842
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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. YALDA DAVOODI
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Credential | DMD
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Telephone | 352-328-5842
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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 | DN21376
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN21376
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License Number State | FL
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