Provider Demographics
NPI:1376984062
Name:AHMED, SHOAIB (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOAIB
Middle Name:
Last Name:AHMED
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 1:2245 KRISTINA PARK
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9340
Mailing Address - Country:US
Mailing Address - Phone:310-254-8527
Mailing Address - Fax:
Practice Address - Street 1:4265 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2802
Practice Address - Country:US
Practice Address - Phone:717-545-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0396241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice