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General NPI Number Information
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NPI Number | 1639552102
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Entity Type | Individual
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Provider Name | CARLY EL HAITAMI DMD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 2511 S ORANGE AVE STE 200
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City | ORLANDO
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State | FL
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Zip | 32806-4545
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Country | US
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Telephone | 217-491-2016
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Fax |
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Provider Business Mailing Address
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Address Line | 10718 BELLE MAISONS DR
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City | ORLANDO
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State | FL
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Zip | 32832-5142
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Country | US
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Telephone | 217-491-2016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN21304
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License Number State | FL
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