Healthcare Provider Details

I. General information

NPI: 1609551100
Provider Name (Legal Business Name): SYED JUNAID QADIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5977
  • Fax: 602-521-5904
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28943
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: