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General NPI Number Information
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NPI Number | 1891599486
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Entity Type | Individual
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Provider Name | ALEXANDER BRADLEY TABATABAI
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 204 W 19TH ST
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2320
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Country | US
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Telephone | 903-572-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 204 W 19TH ST
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2320
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Country | US
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Telephone | 214-645-3979
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Fax | 214-648-7620
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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 | 41972
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License Number State | TX
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