Provider Demographics
NPI:1619491883
Name:MUJTABA, SAMEEN
Entity Type:Individual
Prefix:DR
First Name:SAMEEN
Middle Name:
Last Name:MUJTABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1575
Mailing Address - Country:US
Mailing Address - Phone:704-280-7433
Mailing Address - Fax:
Practice Address - Street 1:5215 EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1575
Practice Address - Country:US
Practice Address - Phone:704-280-7433
Practice Address - Fax:704-280-7433
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist