Basic Information
| Provider Information | |||||||||
| NPI: | 1265163422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FATIMA | ||||||||
| FirstName: | ALINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1724 EMERALD PINES DR | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481882236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346206888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 132 COLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481624104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342427120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2022 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | 2901601418 | MI | Y | Dental Providers | Dentist |
No ID Information.