Provider Demographics
NPI:1043182835
Name:AL MOMANI, AYHAM (RDH)
Entity type:Individual
Prefix:DR
First Name:AYHAM
Middle Name:
Last Name:AL MOMANI
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13245 LONGACRE DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6520
Mailing Address - Country:US
Mailing Address - Phone:689-286-8258
Mailing Address - Fax:
Practice Address - Street 1:3436 S FLORIDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4765
Practice Address - Country:US
Practice Address - Phone:863-607-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH31701124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist