Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 29150 | TX |
NPI | 1487997813 |
---|---|
Provider Name | Amir All-Atabakhsh |
First Address | Houston, TX 77005-3203 |
Second Address | Houston, TX 77005-3203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 30/07/2019 |