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General NPI Number Information
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NPI Number | 1528548351
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Entity Type | Individual
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Provider Name | DR. OSAMA QURESHI
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Gender | Male
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 1963 ROBERT ST S # 100
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City | WEST ST PAUL
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State | MN
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Zip | 55118-3942
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Country | US
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Telephone | 651-724-9689
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 4TH ST SE APT 421
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-4453
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Country | US
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Telephone | 519-992-7787
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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 | D14092
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License Number State | MN
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