MEDICARE: DR. MALIHA FATIMA 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	1223G0001X	General Practice Dentistry	DN22630	FL

General Provider Information

NPI Number	:	1992229504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALIHA FATIMA DMD

Provider Business Mailing Address
First Line	:	3804 NW 78TH WAY APT 243
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-0034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 103RD ST STE 18
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-6789
Country	:	US
Telephone Number	:	904-777-4622
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/26/2017

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