MEDICARE: DR. NAZ HAQUE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	45110	CA
2	1223G0001X	General Practice Dentistry	45110	CA

General Provider Information

NPI Number	:	1083632376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAZ HAQUE DDS

Provider Business Mailing Address
First Line	:	2925 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-505-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-505-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/22/2015

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