Individual provider Active NPI

Rumaisa Altayib

  • General Practice Dentistry
  • Orlando, FL
National Provider Identifier
1912429309
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN24683 Issued in FL
Practice address
4441 Hoffner Ave
Orlando, FL 32812-2331
Phone
(407) 218-4744
NPI assigned
Jul 7, 2017
Last updated
Aug 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12012804A IN
General Practice Dentistry 1223G0001X 2901022278 MI
General Practice Dentistry 1223G0001X DN24683 FL Primary

Addresses

Primary practice location

4441 Hoffner Ave
Orlando, FL 32812-2331

Mailing address

1624 Caribou Hunt TRL
Orlando, FL 32824-5670
Phone (734) 239-2740

Other practice location 1

2429 Ellsworth Rd
Ypsilanti, MI 48197
Phone (734) 434-0043

Other practice location 2

4675 E SR 44 Ste 104
Wildwood, FL 34785-7461
Phone (352) 418-3041

Other practice location 3

2429 Ellsworth Rd
Ypsilanti, MI 48197
Phone (734) 434-0043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN24683FLMDGeneral Practice Dentistry
12012804AINMDGeneral Practice Dentistry
2901022278MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Dreams PLLC General Practice Past Accepting new patients
Sage Dental of Conway PLLC PastSince Aug 29, 2021 Accepting new patients
Wildwood Dentists, PA General Practice Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1912429309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 CARIBOU HUNT TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328245670",
            "telephone_number": "734-239-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4441 HOFFNER AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328122331",
            "telephone_number": "407-218-4744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2429 Ellsworth Rd",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "48197",
            "country_code": "US",
            "telephone_number": "734-434-0043",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4675 E SR 44 Ste 104",
            "address_purpose": "LOCATION",
            "city": "Wildwood",
            "state": "FL",
            "postal_code": "347857461",
            "country_code": "US",
            "telephone_number": "352-418-3041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2429 Ellsworth Rd",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "48197",
            "country_code": "US",
            "telephone_number": "734-434-0043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALTAYIB",
        "first_name": "RUMAISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-07",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012804A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022278",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN24683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.