Provider Demographics
NPI:1144414574
Name:ARDALANI, SHERVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:ARDALANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 SUNRAY DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691
Mailing Address - Country:US
Mailing Address - Phone:727-942-2579
Mailing Address - Fax:
Practice Address - Street 1:4539 SUNRAY DRIVE
Practice Address - Street 2:NONE
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691
Practice Address - Country:US
Practice Address - Phone:727-942-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 169361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics