Provider Demographics
NPI:1730244948
Name:MORSHED, ALY HANY (DDS)
Entity type:Individual
Prefix:
First Name:ALY
Middle Name:HANY
Last Name:MORSHED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-5831
Mailing Address - Country:US
Mailing Address - Phone:850-872-4455
Mailing Address - Fax:850-747-5660
Practice Address - Street 1:3518 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-5831
Practice Address - Country:US
Practice Address - Phone:850-872-4455
Practice Address - Fax:850-747-5660
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65131223G0001X
IA083911223G0001X
FLDN184131223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08391OtherDELTA DENTAL
IA1583088Medicaid
FL001389900Medicaid
NE05082OtherBLUE CROSSBLUE SHIELD
FLDN18413OtherFLORIDA LICENSE
IA01454OtherBLUE CROSS BLUE SHIELD
NE10024989800Medicaid