Provider Demographics
NPI:1447511506
Name:RELAN, KOMAL (DMD)
Entity type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:
Last Name:RELAN
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 1:8131 BAYMEADOWS CIR W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1811
Mailing Address - Country:US
Mailing Address - Phone:904-448-9669
Mailing Address - Fax:904-448-9560
Practice Address - Street 1:8131 BAYMEADOWS CIR W
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1811
Practice Address - Country:US
Practice Address - Phone:904-448-9669
Practice Address - Fax:904-448-9560
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 168281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice