Provider Demographics
NPI:1710088067
Name:MOUALLEM, ALFRED R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:R
Last Name:MOUALLEM
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 1:6610 N UNIVERSITY DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-722-2950
Mailing Address - Fax:
Practice Address - Street 1:6610 N UNIVERSITY DR
Practice Address - Street 2:SUITE #150
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-722-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist