Provider Demographics
NPI:1902951064
Name:AHMAD, DEAN NADEEM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:NADEEM
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NADEEM
Other - Middle Name:
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2049 CULVERHILL WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8805
Mailing Address - Country:US
Mailing Address - Phone:916-770-9034
Mailing Address - Fax:916-434-5575
Practice Address - Street 1:580 N SUNRISE AVE STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3035
Practice Address - Country:US
Practice Address - Phone:916-770-9034
Practice Address - Fax:916-772-0133
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics