Healthcare Provider Details

I. General information

NPI: 1447725973
Provider Name (Legal Business Name): KOMAL SAQIB DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 S GILBERT RD
CHANDLER AZ
85249-5709
US

IV. Provider business mailing address

5095 S GILBERT RD
CHANDLER AZ
85249-5709
US

V. Phone/Fax

Practice location:
  • Phone: 480-887-0817
  • Fax:
Mailing address:
  • Phone: 480-887-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010162
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: