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General NPI Number Information
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NPI Number | 1023695079
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Entity Type | Individual
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Provider Name | MOHAMMAD SAQIB IHSAN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 9408 SW 87TH AVE
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City | MIAMI
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State | FL
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Zip | 33176-2407
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Country | US
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Telephone | 305-440-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 88A FULTON AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07305-3165
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Country | US
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Telephone | 201-736-1297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN28890
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License Number State | FL
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