Provider Demographics
NPI:1730342502
Name:IQBAL, HARIS (DDS)
Entity type:Individual
Prefix:DR
First Name:HARIS
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PENINSULA PL
Mailing Address - Street 2:APT 304
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3295
Mailing Address - Country:US
Mailing Address - Phone:317-413-4794
Mailing Address - Fax:
Practice Address - Street 1:139 CAMBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3295
Practice Address - Country:US
Practice Address - Phone:317-413-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist