Provider Demographics
NPI:1619601820
Name:FATIMA, SIMIL TAMSEEL
Entity Type:Individual
Prefix:
First Name:SIMIL
Middle Name:TAMSEEL
Last Name:FATIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 BALTIMORE ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6050
Mailing Address - Country:US
Mailing Address - Phone:763-231-2050
Mailing Address - Fax:
Practice Address - Street 1:10210 BALTIMORE ST NE STE 100
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6050
Practice Address - Country:US
Practice Address - Phone:763-231-2050
Practice Address - Fax:763-231-2052
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND148071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice