MEDICARE: BUSHRA ALKHEN

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DENT.DE.70036053	WA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN31019	FL

General Provider Information

NPI Number	:	1366321747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUSHRA ALKHEN

Provider Business Mailing Address
First Line	:	4929 SKYWAY DR APT 6208
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-0051
Country	:	US
Telephone Number	:	626-524-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	4929 SKYWAY DR APT 6208
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-0051
Country	:	US
Telephone Number	:	626-524-0009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	09/16/2025

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Directions to “ BUSHRA ALKHEN ” Practice Location

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