Provider Demographics
NPI:1619539889
Name:AKBAR, NASREEN FUAD A (BDS)
Entity Type:Individual
Prefix:MS
First Name:NASREEN
Middle Name:FUAD A
Last Name:AKBAR
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MARTIN LUTHER KING JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208
Mailing Address - Country:US
Mailing Address - Phone:313-494-6611
Mailing Address - Fax:617-636-0310
Practice Address - Street 1:2700 MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208
Practice Address - Country:US
Practice Address - Phone:313-494-6611
Practice Address - Fax:617-636-0310
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-10-05
Deactivation Date:2020-02-17
Deactivation Code:
Reactivation Date:2023-10-05
Provider Licenses
StateLicense IDTaxonomies
MI29520008361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2952000836OtherDENTAL LICENSE
MI5315244562OtherCONTROLLED SUBSTANCE LICENSE