=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356164651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEEN DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2024
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9145 W THUNDERBIRD RD STE 105
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-979-7477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9011 W CARIBBEAN LN
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-881-5761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | DR. MOHAMMED AMEEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 248-881-5761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------