MEDICARE: DR. IBRAHEEM M AL NAQSHABANDY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	36848	TX
2	122300000X	Dentist	DE61085820	WA

General Provider Information

NPI Number	:	1134736028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBRAHEEM M AL NAQSHABANDY DDS

Provider Business Mailing Address
First Line	:	22911 CLAY RD STE 300
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8204
Country	:	US
Telephone Number	:	405-532-0716
Fax Number	:

Provider Business Practice Location Address
First Line	:	22911 CLAY RD STE 300
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8204
Country	:	US
Telephone Number	:	405-532-0716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	11/14/2024

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