Provider Demographics
NPI:1396199956
Name:ADNAN QAYYUM, DDS, LLC
Entity Type:Organization
Organization Name:ADNAN QAYYUM, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QAYYUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-868-1322
Mailing Address - Street 1:4887 HANOVERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9477
Mailing Address - Country:US
Mailing Address - Phone:610-868-1322
Mailing Address - Fax:610-866-3873
Practice Address - Street 1:4887 HANOVERVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9477
Practice Address - Country:US
Practice Address - Phone:610-868-1322
Practice Address - Fax:610-866-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty