Healthcare Provider Details

I. General information

NPI: 1184959454
Provider Name (Legal Business Name): ARIF NAZIR B.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 BALTIMORE ST NE SUITE 100
BLAINE MN
55449-6049
US

IV. Provider business mailing address

10210 BALTIMORE ST NE SUITE 100
BLAINE MN
55449-6049
US

V. Phone/Fax

Practice location:
  • Phone: 763-231-2050
  • Fax: 763-231-2052
Mailing address:
  • Phone: 763-231-2050
  • Fax: 763-231-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13174
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: