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General NPI Number Information
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NPI Number | 1477065969
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Entity Type | Organization
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Legal Business Name | MOHAMMED SUBHANI PA
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 1601 W. TRENTON SUITE J
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 210-749-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 705 WISTERIA AVE
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City | MCALLEN
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State | TX
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Zip | 78504-2839
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Country | US
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Telephone | 210-749-0974
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MOHAMMED AHMED SUBHANI
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Credential | DDS
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Telephone | 210-749-0974
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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 | 27036
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22238
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 27910
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License Number State | TX
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