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Individual

DR. AMIR REZA ARDALAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
374 SW PRIMA VISTA BLVD., PORT ST. LUCIE, FL 34983
(772) 344-4664
(772) 621-4498
Mailing address
833 SW GRAND RESERVE BLVD, PORT ST LUCIE, FL 34986-2341
(772) 878-9617
(772) 878-9617

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN16127
FL

Other

Enumeration date
12/05/2006
Last updated
07/08/2007
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