Provider Demographics
NPI:1124255575
Name:AHSON, IMRAN MOHAMMED (DMD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:MOHAMMED
Last Name:AHSON
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 1:33 TRAFALGAR SQ STE 201
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4901
Mailing Address - Country:US
Mailing Address - Phone:603-595-8889
Mailing Address - Fax:603-595-2027
Practice Address - Street 1:80 LINDALL ST STE 8
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2135
Practice Address - Country:US
Practice Address - Phone:978-777-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045031223S0112X
MADN18583771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery