MEDICARE: SUNNA IMTIAZ AHMAD 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12014644A	IN

General Provider Information

NPI Number	:	1255143152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNA IMTIAZ AHMAD DDS

Provider Business Mailing Address
First Line	:	307 N PENNSYLVANIA ST APT 618
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7365 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2515
Country	:	US
Telephone Number	:	855-720-2470
Fax Number	:

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

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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