Healthcare Provider Details

I. General information

NPI: 1730342502
Provider Name (Legal Business Name): HARIS IQBAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CAMBRIDGE STREET
CAMBRIDGE MA
02139-3295
US

IV. Provider business mailing address

48 PENINSULA PL APT 304
DORCHESTER MA
02125-3295
US

V. Phone/Fax

Practice location:
  • Phone: 317-413-4794
  • Fax:
Mailing address:
  • Phone: 317-413-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: