Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 22281 | TX |
NPI | 1104909803 |
---|---|
Provider Name | Amir D Hosseini |
First Address | San Antonio, TX 78240-4801 |
Second Address | San Antonio, TX 78240-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 11/09/2007 |