Provider Demographics
NPI:1588625289
Name:DANDASHI, MOUTAZ (DMD)
Entity Type:Individual
Prefix:
First Name:MOUTAZ
Middle Name:
Last Name:DANDASHI
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 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:1597 WASHINGTON PIKE STE A5
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2881
Practice Address - Country:US
Practice Address - Phone:412-279-4800
Practice Address - Fax:412-279-7119
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0294151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015280950010Medicaid
PA0015280950011Medicaid
PA0015280950022Medicaid
FL076818900Medicaid
PA0015280950024Medicaid
PA0015280950016Medicaid
PA0015280950020Medicaid
PA0015280950021Medicaid
PA0015280950023Medicaid