Provider Demographics
NPI:1144470295
Name:ISLAM, MOHAMMAD SAIFUL (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SAIFUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 BUCKINGHAM
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2601
Mailing Address - Country:US
Mailing Address - Phone:651-955-6448
Mailing Address - Fax:
Practice Address - Street 1:31118 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1950
Practice Address - Country:US
Practice Address - Phone:651-955-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010214381223G0001X
TX316041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice