Provider Demographics
NPI:1881866267
Name:ISHAQ, MAHEEN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAHEEN
Middle Name:
Last Name:ISHAQ
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 1:448 POST AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2423
Mailing Address - Country:US
Mailing Address - Phone:973-622-3614
Mailing Address - Fax:973-622-1710
Practice Address - Street 1:573 MLK BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1215
Practice Address - Country:US
Practice Address - Phone:973-622-3614
Practice Address - Fax:973-622-1710
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02372000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist