Individual
KHADIDJA GONI-MALLOUMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1547 OHIO AVE, ANDERSON, IN 46016-1917
(765) 641-7499
Mailing address
8950 BRADWELL PL APT 205, FISHERS, IN 46037-8619
(202) 853-4838
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014097A
IN
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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