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General NPI Number Information
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NPI Number | 1063030930
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Entity Type | Individual
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Provider Name | ASHIMA MADAN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 2938 W BAY DR STE C
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City | BELLEAIR BLUFFS
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State | FL
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Zip | 33770-2636
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Country | US
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Telephone | 727-584-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 310 SIGNATURE CT
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-5436
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Country | US
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Telephone | 727-418-9904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25153
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License Number State | FL
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