Provider Demographics
NPI:1922772987
Name:NADIA AHMED, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:NADIA AHMED
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 1:4031 CRESTWIND LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3222
Mailing Address - Country:US
Mailing Address - Phone:832-441-5149
Mailing Address - Fax:
Practice Address - Street 1:1260 MILTON AVE STE 140
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1890
Practice Address - Country:US
Practice Address - Phone:608-757-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002668-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice