Provider Demographics
NPI:1649319690
Name:MOMIN, AYSHA KARIM (DDS)
Entity type:Individual
Prefix:DR
First Name:AYSHA
Middle Name:KARIM
Last Name:MOMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9767 PALMA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3528
Mailing Address - Country:US
Mailing Address - Phone:561-859-6301
Mailing Address - Fax:561-487-7956
Practice Address - Street 1:9767 PALMA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3528
Practice Address - Country:US
Practice Address - Phone:561-859-6301
Practice Address - Fax:561-487-7956
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist