Healthcare Provider Details

I. General information

NPI: 1124959689
Provider Name (Legal Business Name): GAINESVILLE AND OCALA PERIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 NW 40TH TER STE A
GAINESVILLE FL
32606-8149
US

IV. Provider business mailing address

3721 NW 40TH TER STE A
GAINESVILLE FL
32606-8149
US

V. Phone/Fax

Practice location:
  • Phone: 352-745-3405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MALIHA FATIMA
Title or Position: OWNER
Credential: DMD, MS
Phone: 954-804-0487