Healthcare Provider Details

I. General information

NPI: 1134105786
Provider Name (Legal Business Name): SAQIB MUHAMMAD ISHTEEAQUE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47149 BUSE RD BLDG 1370 NAVAL HEALTH CLINIC PATUXENT RIVER
PATUXENT RIVER MD
20670-1540
US

IV. Provider business mailing address

47149 BUSE RD BLDG 1370 NAVAL HEALTH CLINIC PATUXENT RIVER
PATUXENT RIVER MD
20670-1540
US

V. Phone/Fax

Practice location:
  • Phone: 301-757-3698
  • Fax: 301-342-4718
Mailing address:
  • Phone: 301-757-3698
  • Fax: 301-342-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035408
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS035408
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: