Provider Demographics
NPI:1457442865
Name:AHMAD, IRFAN
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 KRISTEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5825
Mailing Address - Country:US
Mailing Address - Phone:321-274-6175
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSEE RD SUITE A-26
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:407-380-7734
Practice Address - Fax:407-380-7741
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice