Provider Demographics
NPI:1518028794
Name:BHUIYAN, MOHAMMED IQBAL (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:IQBAL
Last Name:BHUIYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMUNITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8985
Mailing Address - Country:US
Mailing Address - Phone:570-839-6969
Mailing Address - Fax:570-839-8788
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-6969
Practice Address - Fax:570-839-8788
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036415122300000X
NY000028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02940105Medicaid