1154401339 NPI number — ALAFAYA WOODS COSMETIC AND FAMILY DENTISTRY

Table of content: (NPI 1154401339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154401339 NPI number — ALAFAYA WOODS COSMETIC AND FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAFAYA WOODS COSMETIC AND FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR HOLLY NADJI DMD PA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154401339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 ALAFAYA WOODS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-6235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-977-9888
Provider Business Mailing Address Fax Number:
407-977-7163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 ALAFAYA WOODS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-6235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-977-9888
Provider Business Practice Location Address Fax Number:
407-977-7163
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NADJI
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OWNER
Authorized Official Telephone Number:
407-592-9406

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  14347 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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