Healthcare Provider Details

I. General information

NPI: 1376639005
Provider Name (Legal Business Name): LOUBNA TAHIRI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 HYMEADOW DR SUITE 250
AUSTIN TX
78750-1934
US

IV. Provider business mailing address

8600 RANCH ROAD 620 N APT. 1524
AUSTIN TX
78726-3502
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-5012
  • Fax: 512-219-8510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: