Healthcare Provider Details

I. General information

NPI: 1720675960
Provider Name (Legal Business Name): NAZIR AHMAD DDS VI PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 ELLSTREE LN STE 116
RALEIGH NC
27617-2046
US

IV. Provider business mailing address

5904 SIX FORKS RD STE 101
RALEIGH NC
27609-8228
US

V. Phone/Fax

Practice location:
  • Phone: 919-887-6440
  • Fax:
Mailing address:
  • Phone: 919-539-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NAZIR AHMAD
Title or Position: MANAGER
Credential:
Phone: 919-539-7969