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General NPI Number Information
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NPI Number | 1679959753
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Entity Type | Individual
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Provider Name | SANJEEDA ISLAM HAKIM D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 1401 S 31ST ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3506
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Country | US
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Telephone | 347-536-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 S 31ST ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3506
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Country | US
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Telephone | 347-536-0011
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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 | 0401415171
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042851
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License Number State | PA
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