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NPI Code Detail

MEDICARE: AMBEREEN ANSARI

MEDICARE:   AMBEREEN  ANSARI
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
1122300000XDentist25767TX

General Provider Information

NPI Number : 1659685618
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBEREEN ANSARI
Provider Business Mailing Address
First Line : 4520 HOLLAND AVE APT 104
Second Line :
City : DALLAS
State : TX
Zip : 75219-2141
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4520 HOLLAND AVE APT 104
Second Line :
City : DALLAS
State : TX
Zip : 75219-2141
Country : US
Telephone Number : 972-974-4755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2010
Last Update Date : 08/03/2010

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Directions to “ AMBEREEN ANSARI ” Practice Location

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