1710006267 NPI number — DR. MALINDA JEAN DICE-SHAH D.D.S., M.P.H.

Table of content: DR. MALINDA JEAN DICE-SHAH D.D.S., M.P.H. (NPI 1710006267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710006267 NPI number — DR. MALINDA JEAN DICE-SHAH D.D.S., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICE-SHAH
Provider First Name:
MALINDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710006267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7307 BALTIMORE AVE
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20740-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-985-9100
Provider Business Mailing Address Fax Number:
301-927-1500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7307 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20740-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-985-9100
Provider Business Practice Location Address Fax Number:
301-927-1500
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10258 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112122100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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