=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629790001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALIKA HOJA DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2022
-----------------------------------------------------
Last Update Date | 09/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 CORPORATE DR
-----------------------------------------------------
City | TRUMBULL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06611-1376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-261-2511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 855 BLACK ROCK TPKE APT 5
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06825-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-791-0107
-----------------------------------------------------
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 | 13530
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------