MEDICARE: ALIFIYA BARODAWALLA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901019922	MI

General Provider Information

NPI Number	:	1972751717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIFIYA BARODAWALLA DDS

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	866-273-8204
Fax Number	:

Provider Business Practice Location Address
First Line	:	4459 E BLUE GRASS RD APT D
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-9697
Country	:	US
Telephone Number	:	989-773-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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