Provider Demographics
NPI:1497364228
Name:BAJWA, NAUMAN AHMAD
Entity type:Individual
Prefix:
First Name:NAUMAN
Middle Name:AHMAD
Last Name:BAJWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MIDWAY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5077
Mailing Address - Country:US
Mailing Address - Phone:469-208-6771
Mailing Address - Fax:
Practice Address - Street 1:2101 MIDWAY RD STE 250
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5077
Practice Address - Country:US
Practice Address - Phone:469-208-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2024-09-12
Deactivation Date:2024-08-22
Deactivation Code:
Reactivation Date:2024-09-11
Provider Licenses
StateLicense IDTaxonomies
TX36361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist