Provider Demographics
NPI:1710006267
Name:DICE-SHAH, MALINDA JEAN (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:JEAN
Last Name:DICE-SHAH
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 BALTIMORE AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3231
Mailing Address - Country:US
Mailing Address - Phone:301-985-9100
Mailing Address - Fax:301-927-1500
Practice Address - Street 1:7307 BALTIMORE AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3231
Practice Address - Country:US
Practice Address - Phone:301-985-9100
Practice Address - Fax:301-927-1500
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice