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General NPI Number Information
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NPI Number | 1790107159
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Entity Type | Organization
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Legal Business Name | NEENAH PLAZA DENTISTRY
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 01/20/2014
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Provider Practice Location Address
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Address Line | 9900 W PARMER LN STE A205
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City | AUSTIN
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State | TX
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Zip | 78717-4909
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Country | US
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Telephone | 512-388-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 W PARMER LN STE A205
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City | AUSTIN
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State | TX
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Zip | 78717-4909
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Country | US
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Telephone | 512-388-1833
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MOHAMMAD HABIBZADEH
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Credential | DDS
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Telephone | 512-388-1833
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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 | 26016
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License Number State | TX
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