MEDICARE: TARIQ JAH, DDS, PLLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1861160921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARIQ JAH, DDS, PLLC

Provider Business Mailing Address
First Line	:	109 TALL OAKS DR APT 3H
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3032
Country	:	US
Telephone Number	:	301-254-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 HORSE PEN CREEK RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8387
Country	:	US
Telephone Number	:	301-254-1573
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TARIQAZIZ JAH
Credential	:	DDS
Telephone Number	:	301-254-1573

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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