Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN22279 | FL |
NPI | 1063649580 |
---|---|
Provider Name | Dr. Falastin R. Abu-Samn |
First Address | Lake Mary, FL 32746-4732 |
Second Address | Daytona Beach, FL 32118-5523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 19/01/2017 |