MEDICARE: HAQUE DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	45110	CA

General Provider Information

NPI Number	:	1194849125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAQUE DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2925 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-505-0123
Fax Number	:	714-505-4443

Provider Business Practice Location Address
First Line	:	2925 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-505-0123
Fax Number	:	714-505-4443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NAZ HAQUE
Credential	:	DDS
Telephone Number	:	714-505-0123

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	04/12/2011

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Directions to “HAQUE DENTAL CORPORATION ” Practice Location

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