Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN19943 | FL |
NPI | 1114351392 |
---|---|
Provider Name | Mohammad Khairuz Zaman |
First Address | Oviedo, FL 32765-6376 |
Second Address | Maitland, FL 32751-4411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2013 |
Last Update Date | 30/03/2015 |