Provider Demographics
NPI:1477796373
Name:AQIB MUDASSAR D.D.S INC
Entity Type:Organization
Organization Name:AQIB MUDASSAR D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AQIB
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-662-1010
Mailing Address - Street 1:475 E ALMOND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5750
Mailing Address - Country:US
Mailing Address - Phone:559-662-1010
Mailing Address - Fax:559-662-0942
Practice Address - Street 1:475 E ALMOND AVE STE 103
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5750
Practice Address - Country:US
Practice Address - Phone:559-662-1010
Practice Address - Fax:559-662-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50790261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92948-01OtherMEDICAL