Healthcare Provider Details

I. General information

NPI: 1902264385
Provider Name (Legal Business Name): FATMA BADR BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 NW 39TH AVE APT H44
GAINESVILLE FL
32606-6949
US

IV. Provider business mailing address

5400 NW 39TH AVE APT H44
GAINESVILLE FL
32606-6949
US

V. Phone/Fax

Practice location:
  • Phone: 352-213-1226
  • Fax:
Mailing address:
  • Phone: 352-213-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDRP1243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: