Provider Demographics
NPI:1992442107
Name:QURESHI, HUMZA (DDS)
Entity type:Individual
Prefix:
First Name:HUMZA
Middle Name:
Last Name:QURESHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 COSHOCTON AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-5417
Mailing Address - Country:US
Mailing Address - Phone:740-200-5318
Mailing Address - Fax:
Practice Address - Street 1:1558 COSHOCTON AVE STE 1C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-5417
Practice Address - Country:US
Practice Address - Phone:740-200-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist