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NPI Code Detail

MEDICARE: SHOAA MUQTADIR DDS

MEDICARE: SHOAA MUQTADIR DDS
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
1122300000XDentist2901022155MI

General Provider Information

NPI Number : 1922380666
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOAA MUQTADIR DDS
Provider Business Mailing Address
First Line : 39086 CHESHIRE DR
Second Line :
City : NORTHVILLE
State : MI
Zip : 48167-9174
Country : US
Telephone Number : 248-797-0572
Fax Number :
Provider Business Practice Location Address
First Line : 1658 MIDDLEBELT RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-2879
Country : US
Telephone Number : 734-772-0190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2011
Last Update Date : 04/18/2017

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Directions to “ SHOAA MUQTADIR DDS” Practice Location

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