Provider Demographics
NPI:1417746702
Name:AL SHAMMARI, HUDA
Entity type:Individual
Prefix:
First Name:HUDA
Middle Name:
Last Name:AL SHAMMARI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CORAL BEACH CIR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3401
Mailing Address - Country:US
Mailing Address - Phone:323-781-0233
Mailing Address - Fax:
Practice Address - Street 1:372 CORAL BEACH CIR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3401
Practice Address - Country:US
Practice Address - Phone:323-781-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH33292124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist