Provider Demographics
NPI:1518457266
Name:NIAZ AHMED, DDS, LLC
Entity Type:Organization
Organization Name:NIAZ AHMED, DDS, LLC
Other - Org Name:RIVER PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-785-8831
Mailing Address - Street 1:1111 CROMWELL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3454
Mailing Address - Country:US
Mailing Address - Phone:860-785-8831
Mailing Address - Fax:959-230-4007
Practice Address - Street 1:1111 CROMWELL AVE STE 203
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3454
Practice Address - Country:US
Practice Address - Phone:860-785-8831
Practice Address - Fax:959-230-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11723261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental