Provider Demographics
NPI:1467982736
Name:MUJAHID, NOUMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOUMAN
Middle Name:
Last Name:MUJAHID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 PERIMETER PARK BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1107
Mailing Address - Country:US
Mailing Address - Phone:904-400-3063
Mailing Address - Fax:
Practice Address - Street 1:8708 PERIMETER PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1107
Practice Address - Country:US
Practice Address - Phone:904-400-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist