Provider Demographics
NPI:1205865011
Name:JUREYDA, OSSAMA (DMD)
Entity Type:Individual
Prefix:
First Name:OSSAMA
Middle Name:
Last Name:JUREYDA
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 1:10557 CORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2711
Mailing Address - Country:US
Mailing Address - Phone:716-472-7823
Mailing Address - Fax:813-986-6527
Practice Address - Street 1:17427 BRIDGE HILL CT
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3679
Practice Address - Country:US
Practice Address - Phone:813-972-8999
Practice Address - Fax:813-972-1666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics