=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467268763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | Z FAMILY AND COSMETIC DENTISTRY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2024
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1382 HOWLAND BLVD STE 104
-----------------------------------------------------
City | DELTONA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32738-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-574-7272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11727 ABESS BLVD APT 1209
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32225-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-908-1987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FATIMA A BUTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-908-1987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------