Healthcare Provider Details

I. General information

NPI: 1043911456
Provider Name (Legal Business Name): MAHNOOR MAHMOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 KINGS HWY N
CHERRY HILL NJ
08034-2303
US

IV. Provider business mailing address

5 W STEARNS AVE
HOOKSETT NH
03106-1082
US

V. Phone/Fax

Practice location:
  • Phone: 603-785-6696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03157600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: