Healthcare Provider Details

I. General information

NPI: 1154160661
Provider Name (Legal Business Name): TAMIM HAQ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENERGY PKWY
LAFAYETTE LA
70508-3818
US

IV. Provider business mailing address

104 ENERGY PKWY
LAFAYETTE LA
70508-3818
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-2186
  • Fax: 337-234-1573
Mailing address:
  • Phone: 337-234-2186
  • Fax: 337-234-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: