MEDICARE: MUZZAMMIL AHMED SHUJA DMD

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	1223G0001X	General Practice Dentistry	39929	TX

General Provider Information

NPI Number	:	1811774011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUZZAMMIL AHMED SHUJA DMD

Provider Business Mailing Address
First Line	:	11039 STONE LEGEND DR
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-0072
Country	:	US
Telephone Number	:	832-316-3728
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 W UNIVERSITY DR STE 400
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2952
Country	:	US
Telephone Number	:	832-316-3728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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