Provider Demographics
NPI:1710098553
Name:QURESHI, WAFA A (DDS)
Entity type:Individual
Prefix:DR
First Name:WAFA
Middle Name:A
Last Name:QURESHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 2ND ST S STE 250
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1599
Mailing Address - Country:US
Mailing Address - Phone:715-808-0460
Mailing Address - Fax:
Practice Address - Street 1:400 2ND ST S STE 250
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1599
Practice Address - Country:US
Practice Address - Phone:715-808-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN569198200Medicaid