Individual
HAFSA TAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2016 US HIGHWAY 92 W, AUBURNDALE, FL 33823-3921
(863) 662-9973
Mailing address
1069 ASHTON WOODS LN, LAKELAND, FL 33813-4821
(863) 937-3016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN19118
FL
Other
Enumeration date
12/15/2011
Last updated
12/15/2011
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