Provider Demographics
NPI:1306527585
Name:MUFTI, AWAIS IDRIS
Entity type:Individual
Prefix:
First Name:AWAIS
Middle Name:IDRIS
Last Name:MUFTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 LAKES EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8020
Mailing Address - Country:US
Mailing Address - Phone:812-965-9165
Mailing Address - Fax:
Practice Address - Street 1:817 VILLAGE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3603
Practice Address - Country:US
Practice Address - Phone:719-527-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist