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General NPI Number Information
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NPI Number | 1033665435
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Entity Type | Individual
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Provider Name | MUDHER AL MUDHAFAR
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Gender | Male
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Dates
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Enumeration Date | 08/27/2016
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 2916 N US HIGHWAY 75
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City | SHERMAN
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State | TX
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Zip | 75090-2546
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Country | US
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Telephone | 903-487-0349
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Fax | 678-285-4757
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Provider Business Mailing Address
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Address Line | 8928 E R L THORNTON FWY STE 106
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City | DALLAS
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State | TX
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Zip | 75228-6173
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Country | US
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Telephone | 864-593-6105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857398
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 32897
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License Number State | TX
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