Provider Demographics
NPI:1710098553
Name:QURESHI, WAFA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAFA
Middle Name:A
Last Name:QURESHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:205 WABASHA ST S
Mailing Address - Street 2:PO BOX 1309
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1805
Mailing Address - Country:US
Mailing Address - Phone:651-293-8300
Mailing Address - Fax:651-293-8130
Practice Address - Street 1:15290 PENNOCK LANE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-431-8583
Practice Address - Fax:952-431-8528
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN115981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN569198200Medicaid