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General NPI Number Information
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NPI Number | 1851915003
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Entity Type | Individual
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Provider Name | FASIH UL HAQ DMD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 21750 VALLEY BLVD STE C
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91789-0939
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Country | US
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Telephone | 909-345-1708
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Fax |
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Provider Business Mailing Address
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Address Line | 525 SW 198TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1238
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Country | US
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Telephone | 954-279-6193
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN24867
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107325
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License Number State | CA
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