Provider Demographics
NPI:1760839757
Name:NAZIR AHMAD DDS IV, PA
Entity Type:Organization
Organization Name:NAZIR AHMAD DDS IV, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-283-0100
Mailing Address - Street 1:3150 ROGERS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4196
Mailing Address - Country:US
Mailing Address - Phone:984-833-5200
Mailing Address - Fax:
Practice Address - Street 1:3150 ROGERS RD STE 111
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4196
Practice Address - Country:US
Practice Address - Phone:984-833-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty