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General NPI Number Information
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NPI Number | 1477796373
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Entity Type | Organization
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Legal Business Name | AQIB MUDASSAR D.D.S INC
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 475 E ALMOND AVE STE 103
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City | MADERA
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State | CA
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Zip | 93637-5750
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Country | US
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Telephone | 559-662-1010
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Fax | 559-662-0942
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Provider Business Mailing Address
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Address Line | 475 E ALMOND AVE STE 103
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City | MADERA
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State | CA
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Zip | 93637-5750
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Country | US
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Telephone | 559-662-1010
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Fax | 559-662-0942
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Authorized Official
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Title or Position | DENTIST
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Name | AQIB MUDASSAR
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Credential |
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Telephone | 559-662-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50790
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License Number State | CA
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