Provider Demographics
NPI:1194393595
Name:MOHAMMED SHAFAYETUL ISLAM DDS INC
Entity Type:Organization
Organization Name:MOHAMMED SHAFAYETUL ISLAM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:SHAFAYETUL
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-945-5673
Mailing Address - Street 1:6167 N FRESNO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8610
Mailing Address - Country:US
Mailing Address - Phone:703-945-5673
Mailing Address - Fax:559-981-5375
Practice Address - Street 1:6167 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8610
Practice Address - Country:US
Practice Address - Phone:703-945-5673
Practice Address - Fax:559-981-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental