=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386705200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADIA ANWARI AFZAL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 01/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424 BROADWAY
-----------------------------------------------------
City | FOUNTAIN HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18015-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-867-4461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1424 BROADWAY
-----------------------------------------------------
City | FOUNTAIN HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18015-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-867-4461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS037169
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------