Provider Demographics
NPI:1225266943
Name:DHIMA, MATILDA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:DHIMA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 TERRACE ST
Mailing Address - Street 2:SUITE 3189
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE ST
Practice Address - Street 2:SUITE 3189
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2523
Practice Address - Country:US
Practice Address - Phone:412-648-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0394571223P0700X
MND12734204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00863973OtherMEDICARE - RAIL ROAD
MNENROLLEDMedicaid
MNP00863973OtherMEDICARE - RAIL ROAD