Provider Demographics
NPI:1811774011
Name:SHUJA, MUZZAMMIL AHMED (DMD)
Entity type:Individual
Prefix:
First Name:MUZZAMMIL
Middle Name:AHMED
Last Name:SHUJA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 STONE LEGEND DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-0072
Mailing Address - Country:US
Mailing Address - Phone:832-316-3728
Mailing Address - Fax:
Practice Address - Street 1:3610 W UNIVERSITY DR STE 400
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2952
Practice Address - Country:US
Practice Address - Phone:832-316-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice