Provider Demographics
NPI:1043486293
Name:DR. ADNAN AHMED DDS, INC.
Entity Type:Organization
Organization Name:DR. ADNAN AHMED DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-832-9101
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:OH
Mailing Address - Zip Code:43522-0369
Mailing Address - Country:US
Mailing Address - Phone:419-832-9101
Mailing Address - Fax:419-832-1914
Practice Address - Street 1:24163 FRONT ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:OH
Practice Address - Zip Code:43522-9408
Practice Address - Country:US
Practice Address - Phone:419-832-9101
Practice Address - Fax:419-832-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2406051Medicaid