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General NPI Number Information
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NPI Number | 1679781603
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Entity Type | Individual
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Provider Name | AFSANEH KHORSANDIAN DEAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4916 MILE STRETCH DR
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City | HOLIDAY
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State | FL
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Zip | 34690-4333
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Country | US
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Telephone | 727-938-2866
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Fax | 727-938-2867
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Provider Business Mailing Address
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Address Line | 15616 BEREA DR
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City | ODESSA
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State | FL
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Zip | 33556-3005
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Country | US
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Telephone | 561-261-3390
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Fax | 727-938-2867
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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 | DN16150
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License Number State | FL
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