Provider Demographics
NPI:1538391644
Name:KAMAL, SARIA HUMAYUN
Entity type:Individual
Prefix:DR
First Name:SARIA
Middle Name:HUMAYUN
Last Name:KAMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SARIA
Other - Middle Name:HUMAYUN
Other - Last Name:KAMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4782 LIVERPOOL PL NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3227
Mailing Address - Country:US
Mailing Address - Phone:507-252-0033
Mailing Address - Fax:
Practice Address - Street 1:4782 LIVERPOOL PL NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3227
Practice Address - Country:US
Practice Address - Phone:507-252-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice