Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24935 | FL |
NPI | 1003430455 |
---|---|
Provider Name | Malek Chahada |
First Address | Sebring, FL 33870-1961 |
Second Address | Sebring, FL 33870-1961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 10/08/2020 |