Provider Demographics
NPI:1245470913
Name:ANWAR, ADEEL (DDS)
Entity type:Individual
Prefix:
First Name:ADEEL
Middle Name:
Last Name:ANWAR
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 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0795
Mailing Address - Country:US
Mailing Address - Phone:800-492-4227
Mailing Address - Fax:559-646-3652
Practice Address - Street 1:17008 13TH STREET
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234-9997
Practice Address - Country:US
Practice Address - Phone:800-492-4227
Practice Address - Fax:559-646-3652
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7720122300000X
NV5952122300000X
CA582891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245470913Medicaid