Provider Demographics
NPI:1992426209
Name:MOHAMMED BASEER AHMED, FNU (DMD)
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:MOHAMMED BASEER AHMED
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 1:103 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4509
Mailing Address - Country:US
Mailing Address - Phone:201-417-8417
Mailing Address - Fax:
Practice Address - Street 1:113 TERRACE HALL AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3416
Practice Address - Country:US
Practice Address - Phone:781-221-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18596291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program