Provider Demographics
NPI:1538722087
Name:HAQUE DENTAL CORPORATION
Entity type:Organization
Organization Name:HAQUE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-505-0123
Mailing Address - Street 1:2925 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8909
Mailing Address - Country:US
Mailing Address - Phone:714-505-0123
Mailing Address - Fax:
Practice Address - Street 1:17662 IRVINE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3132
Practice Address - Country:US
Practice Address - Phone:714-505-0116
Practice Address - Fax:714-505-4443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAQUE DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty