Provider Demographics
NPI:1912062423
Name:AHMAD, MOHSENA (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHSENA
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MERIDIAN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2905
Mailing Address - Country:US
Mailing Address - Phone:408-275-0768
Mailing Address - Fax:408-275-0838
Practice Address - Street 1:259 MERIDIAN AVE STE 12
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2905
Practice Address - Country:US
Practice Address - Phone:408-275-0768
Practice Address - Fax:408-275-0838
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94058-01OtherDENTI-CAL