Nasir Kamran Latif, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12215 Issued in MN

Practice address

12936 63Rd Ave N
Maple Grove, MN 55369

Phone

(763) 559-3400

Fax

(763) 559-3900

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Al Shifa Dentistry PA

  • Dental Clinic/Center
  • Maple Grove, MN
  • NPI 1760703151
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1306998265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12936 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-559-3400",
            "fax_number": "763-559-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12936 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-559-3400",
            "fax_number": "763-559-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATIF",
        "first_name": "NASIR",
        "middle_name": "KAMRAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannie Therese Larson, MD
• Lindsey Brooke Larson
• Tailor Larson
• Samuel Larum, PHARMD
• Angela Laschinger
• Brynne Rainier Wilson Latterell, M.D., M.P.H.
• Kaitlyn Leigh Laube Ward, D.P.M.
• Jamie Lawless, CMT
• Lawrence Kotok Leslie Wilcox LLC
• Ava Lawson

• All providers in Maple Grove, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.