Provider Demographics
NPI:1457912040
Name:AHMED, KASHIF (DMD)
Entity Type:Individual
Prefix:
First Name:KASHIF
Middle Name:
Last Name:AHMED
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 1:1583 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2294
Mailing Address - Country:US
Mailing Address - Phone:714-600-2875
Mailing Address - Fax:
Practice Address - Street 1:19510 VAN BUREN BLVD STE F5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9458
Practice Address - Country:US
Practice Address - Phone:951-565-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice