Provider Demographics
NPI:1922380666
Name:MUQTADIR, SHOAA (DDS)
Entity Type:Individual
Prefix:
First Name:SHOAA
Middle Name:
Last Name:MUQTADIR
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 1:39086 CHESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9174
Mailing Address - Country:US
Mailing Address - Phone:248-797-0572
Mailing Address - Fax:
Practice Address - Street 1:1658 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2879
Practice Address - Country:US
Practice Address - Phone:734-772-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist