MEDICARE: DR. ZEENA ALI AL-TIMIMI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD2742	NM

General Provider Information

NPI Number	:	1184702573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZEENA ALI AL-TIMIMI DDS

Provider Business Mailing Address
First Line	:	3900 EUBANK BLVD NE STE 10
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3427
Country	:	US
Telephone Number	:	505-298-7561
Fax Number	:	505-298-7562

Provider Business Practice Location Address
First Line	:	3900 EUBANK BLVD NE STE 10
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3427
Country	:	US
Telephone Number	:	505-298-7561
Fax Number	:	505-298-7562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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