=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588509194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMTC1960 PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10811 FM 359 RD STE 650
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-620-0502
-----------------------------------------------------
Fax | 346-620-0511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10811 FM 359 RD STE 650
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-620-0502
-----------------------------------------------------
Fax | 346-620-0511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BURHANUDDIN JOHAR
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 502-296-9881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------