Provider Demographics
NPI:1952060881
Name:ROYAL DENTAL LLC
Entity Type:Organization
Organization Name:ROYAL DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-740-3100
Mailing Address - Street 1:2335 STATE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4379
Mailing Address - Country:US
Mailing Address - Phone:850-740-3100
Mailing Address - Fax:850-640-0636
Practice Address - Street 1:2335 STATE AVE STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4379
Practice Address - Country:US
Practice Address - Phone:850-740-3100
Practice Address - Fax:850-640-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111298600Medicaid