Provider Demographics
NPI:1790137222
Name:RABBANIFARD, ROYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:RABBANIFARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 BROOKMYRA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5109
Mailing Address - Country:US
Mailing Address - Phone:407-738-1332
Mailing Address - Fax:
Practice Address - Street 1:4120 BROOKMYRA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5109
Practice Address - Country:US
Practice Address - Phone:407-738-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 220621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice