Provider Demographics
NPI:1740632561
Name:MUTWAHIR, TAUSEEF (DMD)
Entity type:Individual
Prefix:
First Name:TAUSEEF
Middle Name:
Last Name:MUTWAHIR
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 1:909 SUMNEYTOWN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1011
Mailing Address - Country:US
Mailing Address - Phone:215-643-5220
Mailing Address - Fax:215-643-3575
Practice Address - Street 1:909 SUMNEYTOWN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1011
Practice Address - Country:US
Practice Address - Phone:215-643-5220
Practice Address - Fax:215-643-3575
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0408291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice