Individual
KISA IQBAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
635 ALBANY ST, BOSTON, MA 02118-3550
(347) 827-6410
Mailing address
309 RANDY MATSON AVE, PAMPA, TX 79065-4305
(347) 827-6410
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
37079
TX
1223G0001X
General Practice Dentistry
Primary
DN1859264
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/07/2020
Last updated
10/05/2023
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