Provider Demographics
NPI:1083622708
Name:ARIFUDDIN, ALI M (DDS)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:ARIFUDDIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ABUL KHAIR
Other - Middle Name:MOHAMMED
Other - Last Name:ARIFUDDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:1379 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3603
Practice Address - Country:US
Practice Address - Phone:407-933-8686
Practice Address - Fax:407-933-2262
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice