Provider Demographics
NPI:1184304388
Name:MOHIUDDEEN, AZEEM SYED (DMD)
Entity type:Individual
Prefix:DR
First Name:AZEEM
Middle Name:SYED
Last Name:MOHIUDDEEN
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 1:6636 SW 81ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5630
Mailing Address - Country:US
Mailing Address - Phone:352-256-8005
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D1-19
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-7846
Practice Address - Fax:352-273-7848
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN280711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics