Provider Demographics
NPI:1528548351
Name:QURESHI, OSAMA
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:QURESHI
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 1:2900 4TH ST SE APT 421
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4453
Mailing Address - Country:US
Mailing Address - Phone:519-992-7787
Mailing Address - Fax:
Practice Address - Street 1:1963 ROBERT ST S # 100
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3942
Practice Address - Country:US
Practice Address - Phone:651-724-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice