Provider Demographics
NPI:1407239023
Name:DAVOODI, YALDA (DMD)
Entity type:Individual
Prefix:DR
First Name:YALDA
Middle Name:
Last Name:DAVOODI
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 1:6000 TOSCANA DR
Mailing Address - Street 2:APT 438
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3482
Mailing Address - Country:US
Mailing Address - Phone:352-328-5842
Mailing Address - Fax:
Practice Address - Street 1:6000 TOSCANA DR
Practice Address - Street 2:APT 438
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3482
Practice Address - Country:US
Practice Address - Phone:352-328-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist