Provider Demographics
NPI:1770077646
Name:LAKHANI, JUNAID ANIS
Entity type:Individual
Prefix:
First Name:JUNAID
Middle Name:ANIS
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9658 W MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3364
Mailing Address - Country:US
Mailing Address - Phone:347-856-9785
Mailing Address - Fax:
Practice Address - Street 1:24185 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7819
Practice Address - Country:US
Practice Address - Phone:863-940-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist