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General NPI Number Information
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NPI Number | 1295469278
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Entity Type | Individual
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Provider Name | SELMA GHASSAN MAHMOUD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 6500 N MOPAC EXPY STE 2204
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City | AUSTIN
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State | TX
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Zip | 78731-3282
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Country | US
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Telephone | 512-489-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 11900 DEERING PL
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City | AUSTIN
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State | TX
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Zip | 78726-4101
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Country | US
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Telephone | 512-825-7163
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 38437
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License Number State | TX
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