Provider Demographics
NPI:1184214934
Name:MATILDA DHIMA DMD,MS PLLC
Entity Type:Organization
Organization Name:MATILDA DHIMA DMD,MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:215-459-0600
Mailing Address - Street 1:2054 KILDAIRE FARM RD # 425
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6614
Mailing Address - Country:US
Mailing Address - Phone:984-677-2020
Mailing Address - Fax:984-677-1010
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 111
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:984-677-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty