Provider Demographics
NPI:1164604997
Name:MOOPEN, ANZIR M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANZIR
Middle Name:M
Last Name:MOOPEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 S CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7331
Mailing Address - Country:US
Mailing Address - Phone:407-658-0280
Mailing Address - Fax:407-658-4080
Practice Address - Street 1:3150 S CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7331
Practice Address - Country:US
Practice Address - Phone:407-658-0280
Practice Address - Fax:407-658-4080
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 173031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics