Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 35219 | TX |
NPI | 1003477639 |
---|---|
Provider Name | Nadia Mohammadi |
First Address | Austin, TX 78704 |
Second Address | New Braunfels, TX 78130-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |