Provider Demographics
NPI:1174859920
Name:AL-HAMMALI, NADINE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:M
Last Name:AL-HAMMALI
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 1:650 ARBOR GLEN CIR
Mailing Address - Street 2:APT 208
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:213-400-6882
Mailing Address - Fax:678-247-7829
Practice Address - Street 1:329 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-877-1300
Practice Address - Fax:770-916-5362
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN255601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice