Provider Demographics
NPI:1881451037
Name:ANJUM, AYESHA (DMD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:ANJUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:ANJUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:15801 ARTIST WAY APT 4213
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6179
Mailing Address - Country:US
Mailing Address - Phone:270-799-3260
Mailing Address - Fax:
Practice Address - Street 1:3030 LYNDON B JOHNSON FWY STE 1700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2759
Practice Address - Country:US
Practice Address - Phone:972-663-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX41130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program