Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 24797 | TX |
N | 1223P0300X | Periodontist | S-461 | LA |
NPI | 1154557072 |
---|---|
Provider Name | Dr. Houssam Eddin Alghadban |
First Address | San Antonio, TX 78258-4113 |
Second Address | San Antonio, TX 78258-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 12/11/2009 |