Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS039457 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | D12734 | MN |
NPI | 1225266943 |
---|---|
Provider Name | Matilda Dhima |
First Address | Pittsburgh, PA 15213-2523 |
Second Address | Pittsburgh, PA 15213-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 03/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190001054 | (02) | MN |
ENROLLED | (05) | MN |
P00863973 | MEDICARE - RAIL ROAD (01) | MN |