=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932366184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ADNAN AHMED DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 06/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 775 W SOUTH BOUNDARY ST
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-893-8431
-----------------------------------------------------
Fax | 419-893-7234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2444 DETROIT AVE
-----------------------------------------------------
City | MAUMEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43537-3715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-893-8431
-----------------------------------------------------
Fax | 419-893-7234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ADNAN AHMED
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 419-893-8431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 21695
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------