Healthcare Provider Details

I. General information

NPI: 1932647484
Provider Name (Legal Business Name): AZ DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ROUTE 101A
AMHERST NH
03031-2274
US

IV. Provider business mailing address

71 ROUTE 101A
AMHERST NH
03031-2274
US

V. Phone/Fax

Practice location:
  • Phone: 603-672-6546
  • Fax:
Mailing address:
  • Phone: 603-672-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04286
License Number StateNH

VIII. Authorized Official

Name: DR. HAJRA OMER SHEIKH
Title or Position: MEMBER/DENTIST
Credential: DMD
Phone: 201-334-8648