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General NPI Number Information
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NPI Number | 1770281693
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Entity Type | Individual
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Provider Name | ALIYYAH DEWJI
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3555 N COUNTY ROAD 19A
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City | MOUNT DORA
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State | FL
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Zip | 32757-5301
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Country | US
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Telephone | 352-575-0943
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROOKDALE PLZ
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City | BROOKLYN
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State | NY
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Zip | 11212-3139
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | DN28712
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License Number State | FL
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