Provider Demographics
NPI:1710102223
Name:IQBAL, MOHAMMED WAQAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:WAQAS
Last Name:IQBAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 FRANKLIN AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3250
Mailing Address - Country:US
Mailing Address - Phone:201-445-7535
Mailing Address - Fax:201-445-8106
Practice Address - Street 1:172 FRANKLIN AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3250
Practice Address - Country:US
Practice Address - Phone:201-445-7535
Practice Address - Fax:201-445-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022481001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice