Provider Demographics
NPI:1093378192
Name:MAHMOOD, AYZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AYZA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7588 TOSCANA BLVD APT 411
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5524
Mailing Address - Country:US
Mailing Address - Phone:586-668-1236
Mailing Address - Fax:
Practice Address - Street 1:4401 S ORANGE AVE STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6969
Practice Address - Country:US
Practice Address - Phone:407-851-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238951223G0001X
FLDN238951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice