Provider Demographics
NPI:1861669533
Name:HUQ, SYEDA SHABNAM
Entity Type:Individual
Prefix:
First Name:SYEDA
Middle Name:SHABNAM
Last Name:HUQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LENORE CT
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7523
Mailing Address - Country:US
Mailing Address - Phone:480-363-7215
Mailing Address - Fax:
Practice Address - Street 1:132 LENORE CT
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7523
Practice Address - Country:US
Practice Address - Phone:480-363-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist