Provider Demographics
NPI:1942042668
Name:SHERIFF, MUBASHIR (DMD)
Entity type:Individual
Prefix:
First Name:MUBASHIR
Middle Name:
Last Name:SHERIFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10642 WESTON WAY N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4163
Mailing Address - Country:US
Mailing Address - Phone:516-234-9787
Mailing Address - Fax:
Practice Address - Street 1:4930 42ND AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1731
Practice Address - Country:US
Practice Address - Phone:763-537-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist