Provider Demographics
NPI:1912429309
Name:ALTAYIB, RUMAISA
Entity Type:Individual
Prefix:
First Name:RUMAISA
Middle Name:
Last Name:ALTAYIB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 CARIBOU HUNT TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5670
Mailing Address - Country:US
Mailing Address - Phone:734-239-2740
Mailing Address - Fax:
Practice Address - Street 1:4441 HOFFNER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2331
Practice Address - Country:US
Practice Address - Phone:407-218-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012804A1223G0001X
MI29010222781223G0001X
FLDN246831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice