Healthcare Provider Details

I. General information

NPI: 1942127725
Provider Name (Legal Business Name): MUJAHID ABDULWAHAB ASAMARAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HIGHWAY 65 NE STE 104
SPRING LAKE PARK MN
55432-4511
US

IV. Provider business mailing address

8097 HIGHWAY 65 NE STE 104
MINNEAPOLIS MN
55432-4511
US

V. Phone/Fax

Practice location:
  • Phone: 763-307-8689
  • Fax: 763-307-8649
Mailing address:
  • Phone: 763-307-8689
  • Fax: 763-307-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15509
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: