1417393729 NPI number — DR. AHMAD MOUSABAKHIT AL MANASIR DDS

Table of content: DR. AHMAD MOUSABAKHIT AL MANASIR DDS (NPI 1417393729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417393729 NPI number — DR. AHMAD MOUSABAKHIT AL MANASIR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL MANASIR
Provider First Name:
AHMAD
Provider Middle Name:
MOUSABAKHIT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417393729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N CONWAY AVE
Provider Second Line Business Mailing Address:
APT 310
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-5361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-585-2000
Provider Business Mailing Address Fax Number:
956-585-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4533 LOS FELIZ BLVD
Provider Second Line Business Practice Location Address:
APT 310
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-553-5802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  28839 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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