Provider Demographics
NPI:1225048796
Name:ISLAM, ABUL KHAYER (BDS)
Entity Type:Individual
Prefix:DR
First Name:ABUL
Middle Name:KHAYER
Last Name:ISLAM
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:K
Other - Last Name:ISLAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS
Mailing Address - Street 1:1925 E MICHIGAN STREET
Mailing Address - Street 2:SUITE101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4978
Mailing Address - Country:US
Mailing Address - Phone:407-896-6336
Mailing Address - Fax:407-894-9772
Practice Address - Street 1:1925 E MICHIGAN STREET
Practice Address - Street 2:SUITE101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4978
Practice Address - Country:US
Practice Address - Phone:407-896-6336
Practice Address - Fax:407-894-9772
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073903100Medicaid