Healthcare Provider Details

I. General information

NPI: 1184059792
Provider Name (Legal Business Name): NAZIR AHMAD DDS III, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 S CHURCH ST
BURLINGTON NC
27215-5202
US

IV. Provider business mailing address

853 HEATHER RD
BURLINGTON NC
27215-6288
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-4500
  • Fax: 919-882-8545
Mailing address:
  • Phone: 336-252-3700
  • Fax: 336-252-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8564
License Number StateNC

VIII. Authorized Official

Name: NAZIR AHMAD
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 919-322-4500