=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023531407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AZHAR AHMED DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 N DALLAS AVE
-----------------------------------------------------
City | LAMESA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79331-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-870-5555
-----------------------------------------------------
Fax | 806-870-5559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 N DALLAS AVE
-----------------------------------------------------
City | LAMESA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79331-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 18068939897
-----------------------------------------------------
Fax | 806-870-5559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 33326
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------