MEDICARE: MOHAMMAD EYAD ALBABA 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	37472	TX
2	122300000X	Dentist	11650	TN

General Provider Information

NPI Number	:	1225609993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD EYAD ALBABA DDS

Provider Business Mailing Address
First Line	:	1608 GARDEN GLEN LN
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-6559
Country	:	US
Telephone Number	:	832-621-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 KELSEY LN STE 1
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6480
Country	:	US
Telephone Number	:	865-317-4353
Fax Number	:

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

Provider Enumeration Date	:	07/05/2021
Last Update Date	:	07/28/2021

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