MEDICARE: NADEEN JAMAL DMD

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	30.024942	OH
2	122300000X	Dentist	DEN.00203088	CO
3	122300000X	Dentist	DN22334	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891142808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEEN JAMAL DMD

Provider Business Mailing Address
First Line	:	14511 NETTLE CREEK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2640
Country	:	US
Telephone Number	:	813-417-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2091 COLLIER PKWY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5202
Country	:	US
Telephone Number	:	813-948-6290
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	04/15/2022

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Directions to “ NADEEN JAMAL DMD” Practice Location

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