Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02758100 | NJ |
NPI | 1043665706 |
---|---|
Provider Name | Dr. Maheen Kibria |
First Address | Somerville, NJ 08876-2020 |
Second Address | Perth Amboy, NJ 08861-2370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2016 |
Last Update Date | 28/08/2020 |