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General NPI Number Information
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NPI Number | 1134587579
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Entity Type | Individual
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Provider Name | ADISA HAMATAJ DDS
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Gender | Female
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Dates
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Enumeration Date | 01/30/2016
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 9915 W MCDOWELL RD # ARE106
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City | AVONDALE
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State | AZ
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Zip | 85392-4896
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Country | US
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Telephone | 623-907-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 6975 E PRINCESS DR APT 3120
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City | PHOENIX
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State | AZ
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Zip | 85054-4234
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Country | US
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Telephone | 917-664-5944
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2016013929
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D010375
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License Number State | AZ
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