Provider Demographics
NPI:1629452545
Name:AHMED, MOHAMMED MUSHTAQ
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:MUSHTAQ
Last Name:AHMED
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 1:7827 N WICKHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8289
Mailing Address - Country:US
Mailing Address - Phone:321-434-4444
Mailing Address - Fax:
Practice Address - Street 1:7827 N WICKHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8289
Practice Address - Country:US
Practice Address - Phone:321-434-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist