MEDICARE: GM DENTAL, PC

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	1223G0001X	General Practice Dentistry	22DI01848600	NJ

General Provider Information

NPI Number	:	1588602635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GM DENTAL, PC

Provider Business Mailing Address
First Line	:	302 N WASHINGTON AVE
Second Line	:	SUITE 102 W
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-2448
Country	:	US
Telephone Number	:	856-222-3445
Fax Number	:	856-222-3446

Provider Business Practice Location Address
First Line	:	302 N WASHINGTON AVE
Second Line	:	SUITE 102 W
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-2448
Country	:	US
Telephone Number	:	856-222-3445
Fax Number	:	856-222-3446

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GHINA C MALIHA
Credential	:	D.M.D.
Telephone Number	:	856-222-3445

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/22/2020

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