Healthcare Provider Details

I. General information

NPI: 1871343715
Provider Name (Legal Business Name): AHMAD MINHAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE, 60 2ND ST #1
HACKENSACK NJ
07601
US

IV. Provider business mailing address

30 PROSPECT AVE, 60 2ND ST #1
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3492
  • Fax: 551-996-0530
Mailing address:
  • Phone: 551-996-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0134321
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: