Roz Aghaaliandastjerdi, DMD
Individual provider Active NPI Dentist · Palm Coast, FL
NPI 1427649755 · NPPES record last updated Aug 18, 2021
Key facts
- NPI
- 1427649755
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN25014 (FL)
- Practice address
- 4873 Belle Terre Pkwy
Palm Coast, FL 32137-8696 - Phone
- (386) 864-8313
- NPI assigned
- Jan 29, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN25014 | FL | MD | Dentist |
| 36784 | TX | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 36784 | TX | |
| Dentist | 122300000X | DN25014 | FL | Yes |
Addresses
Primary practice location
4873 Belle Terre Pkwy
Palm Coast, FL 32137-8696
Mailing address
12341 NW 26TH St
Plantation, FL 33323-1773
Phone (954) 218-9052
Other practice location 1
6940 Coit Rd Ste 200
Plano, TX 75023-1084
Phone (469) 290-3601
Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.