Provider Demographics
NPI:1689939159
Name:A.K.M.W.ISLAM,BDS,P.A.
Entity Type:Organization
Organization Name:A.K.M.W.ISLAM,BDS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-896-6336
Mailing Address - Street 1:1925 E MICHIGAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 E MICHIGAN ST
Practice Address - Street 2:SUITE 101
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty