Maryam Lina Waseem, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN29167 Issued in FL

Practice address

17365 US Highway 441 FL 32757
Mount Dora, FL 32757-6715

Phone

(352) 270-3015

NPI assigned

Jun 19, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mount Dora Modern Dentistry, PA

  • General Practice Dentistry
  • Eustis, FL
  • NPI 1659815306
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1437993011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 MAJORCA PL APT 5041",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328195561",
            "telephone_number": "954-707-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17365 US HIGHWAY 441 FL 32757",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576715",
            "telephone_number": "352-270-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASEEM",
        "first_name": "MARYAM",
        "middle_name": "LINA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN29167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert A Walther, PA-C
• Angela O Ward, RN
• Meagan Ward, ATR
• Dinah McCarley Warner, M.D.
• Jordan Nicole Warren
• Waterman Communities Inc
• Waterman Communities Inc
• Waterman Communities Inc
• Waterman Communities Inc
• Waterman Communities Inc

• General Practice Dentistry in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.