MEDICARE: GEM DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275481079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEM DENTAL PLLC

Provider Business Mailing Address
First Line	:	1060 W STATE ROAD 434 STE 148
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4954
Country	:	US
Telephone Number	:	407-960-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 W STATE ROAD 434 STE 148
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4954
Country	:	US
Telephone Number	:	407-960-1414
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. AYMAN ATALLAH
Credential	:	DDS
Telephone Number	:	904-704-7547

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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