Provider Demographics
NPI:1487204350
Name:UTTMA S DHAM , DMD PA
Entity Type:Organization
Organization Name:UTTMA S DHAM , DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UTTMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-476-4535
Mailing Address - Street 1:51 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7007
Mailing Address - Country:US
Mailing Address - Phone:954-476-4535
Mailing Address - Fax:954-476-7684
Practice Address - Street 1:51 NW 100TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7007
Practice Address - Country:US
Practice Address - Phone:954-476-4535
Practice Address - Fax:954-476-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty