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General NPI Number Information
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NPI Number | 1033925755
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Entity Type | Individual
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Provider Name | MUHAMMAD MUMTAZ
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Gender | Male
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1124 W OLIVE AVE
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City | MERCED
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State | CA
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Zip | 95348-1939
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Country | US
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Telephone | 209-205-4288
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Fax |
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Provider Business Mailing Address
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Address Line | 227 SOUTH AVE
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City | TURLOCK
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State | CA
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Zip | 95380-5643
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Country | US
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Telephone | 209-986-3025
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 111070
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License Number State | CA
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