Provider Demographics
NPI:1891866752
Name:AHMED, ADNAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:
Last Name:AHMED
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 1:775 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5226
Mailing Address - Country:US
Mailing Address - Phone:419-893-8431
Mailing Address - Fax:419-893-7234
Practice Address - Street 1:775 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5226
Practice Address - Country:US
Practice Address - Phone:419-893-8431
Practice Address - Fax:419-893-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0216951223G0001X
OH300216951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2834624Medicaid