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General NPI Number Information
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NPI Number | 1417393729
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Entity Type | Individual
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Provider Name | AHMAD MOUSABAKHIT AL MANASIR DDS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 4533 LOS FELIZ BLVD APT 310
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City | LOS ANGELES
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State | CA
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Zip | 90027-2057
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Country | US
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Telephone | 714-553-5802
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N CONWAY AVE APT 310
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City | MISSION
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State | TX
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Zip | 78572-5361
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Country | US
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Telephone | 956-585-2000
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Fax | 956-585-2001
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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 | 28839
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License Number State | TX
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