Provider Demographics
NPI:1497364228
Name:BAJWA, NAUMAN AHMAD
Entity Type:Individual
Prefix:
First Name:NAUMAN
Middle Name:AHMAD
Last Name:BAJWA
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 1:24920 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0202
Mailing Address - Country:US
Mailing Address - Phone:909-602-6876
Mailing Address - Fax:
Practice Address - Street 1:404 N TEMPLE DR
Practice Address - Street 2:
Practice Address - City:DIBOLL
Practice Address - State:TX
Practice Address - Zip Code:75941-1736
Practice Address - Country:US
Practice Address - Phone:936-526-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist