Provider Demographics
NPI:1841563368
Name:ISLAM, MAHRUFA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHRUFA
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 JEAN PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4509
Mailing Address - Country:US
Mailing Address - Phone:504-885-6365
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVENUE
Practice Address - Street 2:
Practice Address - City:NEWORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-941-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAS-5541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics