Provider Demographics
NPI:1144901463
Name:ELTANTAWY, MAI (DMD)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:
Last Name:ELTANTAWY
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 1:17804 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1673
Mailing Address - Country:US
Mailing Address - Phone:954-651-3677
Mailing Address - Fax:
Practice Address - Street 1:12851 NARCOOSSEE RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7156
Practice Address - Country:US
Practice Address - Phone:407-749-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice