Healthcare Provider Details

I. General information

NPI: 1750823746
Provider Name (Legal Business Name): NAZIR AHMAD DDS V PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BLUE RIDGE RD STE 201
RALEIGH NC
27607-7515
US

IV. Provider business mailing address

2500 BLUE RIDGE RD STE 201
RALEIGH NC
27607-7515
US

V. Phone/Fax

Practice location:
  • Phone: 197-839-9209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MANAGER
Credential: DDS
Phone: 919-783-9920