Healthcare Provider Details

I. General information

NPI: 1124709928
Provider Name (Legal Business Name): FAHIM VOHRA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELAWARE ST SE, SCHOOL OF DENTISTRY
MINEAPOLIS MN
55455
US

IV. Provider business mailing address

17795 32ND PL N
PLYMOUTH MN
55447-1692
US

V. Phone/Fax

Practice location:
  • Phone: 612-986-1774
  • Fax:
Mailing address:
  • Phone: 612-986-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberFL66
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: