Provider Demographics
NPI:1932647484
Name:AZ DENTAL PLLC
Entity Type:Organization
Organization Name:AZ DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAJRA
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-334-8648
Mailing Address - Street 1:71 ROUTE 101A
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2274
Mailing Address - Country:US
Mailing Address - Phone:603-672-6546
Mailing Address - Fax:
Practice Address - Street 1:71 ROUTE 101A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2274
Practice Address - Country:US
Practice Address - Phone:603-672-6546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty