Provider Demographics
NPI:1124458609
Name:TIWANA, FATIMA A (BDS)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:A
Last Name:TIWANA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 EAGLE POINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8624
Mailing Address - Country:US
Mailing Address - Phone:651-523-9950
Mailing Address - Fax:
Practice Address - Street 1:8515 EAGLE POINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8624
Practice Address - Country:US
Practice Address - Phone:651-523-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics