Provider Demographics
NPI:1346466612
Name:HUQ, MOHAMMED NAZMUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:NAZMUL
Last Name:HUQ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 BRODICK LN
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-6892
Mailing Address - Country:US
Mailing Address - Phone:404-933-3592
Mailing Address - Fax:770-732-9778
Practice Address - Street 1:3383 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1450
Practice Address - Country:US
Practice Address - Phone:770-732-9222
Practice Address - Fax:770-732-9778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice