MEDICARE: NAZIR AHMAD DDS V PA

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8564	NC

General Provider Information

NPI Number	:	1750823746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZIR AHMAD DDS V PA

Provider Business Mailing Address
First Line	:	2500 BLUE RIDGE RD STE 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 BLUE RIDGE RD STE 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7515
Country	:	US
Telephone Number	:	197-839-9209
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NAZIR AHMAD
Credential	:	DDS
Telephone Number	:	919-783-9920

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	09/16/2020

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