=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477165561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMINA MEKIC DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8732 UNIVERSITY CITY BLVD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28213-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-549-1911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2103 OAKCLIFFE CT
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28075-6701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-360-2785
-----------------------------------------------------
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 | 0401417125
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 13662
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------