Provider Demographics
NPI:1477750263
Name:ISLAM, MOHAMMED NADIMUL (DDS, BDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:NADIMUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:DDS, BDS
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Mailing Address - Street 1:1111 SW 16TH AVENUE APT 49
Mailing Address - Street 2:PARK 16TH TOWN HOUSES
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8497
Mailing Address - Country:US
Mailing Address - Phone:352-262-7857
Mailing Address - Fax:352-294-5311
Practice Address - Street 1:1395 CENTER DR
Practice Address - Street 2:RM D8-6C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0405
Practice Address - Country:US
Practice Address - Phone:352-294-5711
Practice Address - Fax:352-294-5310
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12011554A1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM429YMedicare PIN