Provider Demographics
NPI:1043365372
Name:IKHLAQ-ROSINSKI, HUMAIRA (DDS,BDS)
Entity Type:Individual
Prefix:DR
First Name:HUMAIRA
Middle Name:
Last Name:IKHLAQ-ROSINSKI
Suffix:
Gender:F
Credentials:DDS,BDS
Other - Prefix:
Other - First Name:HUMAIRA
Other - Middle Name:
Other - Last Name:IKHLAQ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, BDS
Mailing Address - Street 1:214 SCHILLER ST
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-1152
Mailing Address - Country:US
Mailing Address - Phone:573-486-5431
Mailing Address - Fax:
Practice Address - Street 1:20 DANA BUILDING HOWARD AVE
Practice Address - Street 2:2 FLOOR DENTAL CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO20100406041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program