Healthcare Provider Details

I. General information

NPI: 1144470295
Provider Name (Legal Business Name): MOHAMMAD SAIFUL ISLAM DDS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 TAILWIND DR STE 200
MANKATO MN
56001-6277
US

IV. Provider business mailing address

17350 BAINBRIDGE DR
EDEN PRAIRIE MN
55347-2295
US

V. Phone/Fax

Practice location:
  • Phone: 507-388-2200
  • Fax:
Mailing address:
  • Phone: 651-955-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021438
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31604
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD13906
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: