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General NPI Number Information
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NPI Number | 1851479265
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Entity Type | Organization
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Legal Business Name | KAWVEH NOFALLAH DMD PA
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 3624 HARDEN BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-5938
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Country | US
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Telephone | 863-648-5338
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Fax | 863-648-5890
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Provider Business Mailing Address
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Address Line | 3624 HARDEN BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-5938
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Country | US
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Telephone | 863-648-5338
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Fax | 863-648-5890
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Authorized Official
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Title or Position | OWNER-DENTIST
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Name | DR. KAWVEH NOFALLAH
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Credential | DMD
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Telephone | 863-648-5338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 17075
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License Number State | FL
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