Basic Information
| Provider Information | |||||||||
| NPI: | 1336405976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAMIM | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 E BIJOU ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809098009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195761850 | ||||||||
| FaxNumber: | 7199553470 | ||||||||
| Practice Location | |||||||||
| Address1: | 3946 MINNESOTA AVE NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023971033 | ||||||||
| FaxNumber: | 2023972104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 34757 | TX | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223S0112X | 16697 | MD | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
ID Information
| ID | Type | State | Issuer | Description | 16697 | 01 | MD | MD DENTAL LICENSE | OTHER | DEN1001967 | 01 | DC | DENTAL LICENSE | OTHER |