Provider Demographics
NPI:1083842421
Name:AHMAD, M. FAROOQ (DDS, MBA)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:FAROOQ
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4039
Mailing Address - Country:US
Mailing Address - Phone:760-407-0104
Mailing Address - Fax:760-407-0103
Practice Address - Street 1:1245 E VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4039
Practice Address - Country:US
Practice Address - Phone:760-407-0104
Practice Address - Fax:760-407-0103
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist