Provider Demographics
NPI:1134105786
Name:ISHTEEAQUE, SAQIB MUHAMMAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAQIB
Middle Name:MUHAMMAD
Last Name:ISHTEEAQUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47149 BUSE RD BLDG 1370
Mailing Address - Street 2:NAVAL HEALTH CLINIC PATUXENT RIVER
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-1540
Mailing Address - Country:US
Mailing Address - Phone:301-757-3698
Mailing Address - Fax:301-342-4718
Practice Address - Street 1:47149 BUSE RD BLDG 1370
Practice Address - Street 2:NAVAL HEALTH CLINIC PATUXENT RIVER
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-1540
Practice Address - Country:US
Practice Address - Phone:301-757-3698
Practice Address - Fax:301-342-4718
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035408122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist