Provider Demographics
NPI:1881901999
Name:HALEM, EVELYN MIRANDA (DMD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MIRANDA
Last Name:HALEM
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 1:1405 S HIAWASSEE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5786
Mailing Address - Country:US
Mailing Address - Phone:407-294-6009
Mailing Address - Fax:407-294-2722
Practice Address - Street 1:1405 S HIAWASSEE RD STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5786
Practice Address - Country:US
Practice Address - Phone:407-294-6009
Practice Address - Fax:407-294-2722
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist