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General NPI Number Information
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NPI Number | 1922735158
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Entity Type | Individual
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Provider Name | NIDA AQIL DMD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 10288 77TH ST STE 300
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1134
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Country | US
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Telephone | 262-697-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 WENTWORTH DR
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City | VOLO
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State | IL
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Zip | 60020-3416
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Country | US
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Telephone | 302-268-0336
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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 | 6001043-15
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License Number State | WI
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