Provider Demographics
NPI:1023695079
Name:IHSAN, MOHAMMAD SAQIB (DMD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD SAQIB
Middle Name:
Last Name:IHSAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88A FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3165
Mailing Address - Country:US
Mailing Address - Phone:201-736-1297
Mailing Address - Fax:
Practice Address - Street 1:9408 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2407
Practice Address - Country:US
Practice Address - Phone:305-440-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN288901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics