=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114373354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAIR DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2016
-----------------------------------------------------
Last Update Date | 05/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2028 WIRT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-300-8444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2028 WIRT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-300-8444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DR. MUSSADIQ IFTIKHAR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 83230084444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 28241
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------