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NPI Code Detail

MEDICARE: HAJRA MUJTABA DMD

MEDICARE: HAJRA MUJTABA DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry34688TX

General Provider Information

NPI Number : 1720554843
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAJRA MUJTABA DMD
Provider Business Mailing Address
First Line : 5702 TIMBERGATE DR APT 608
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78414-3184
Country : US
Telephone Number : 617-870-1406
Fax Number :
Provider Business Practice Location Address
First Line : 4224 AYERS ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5317
Country : US
Telephone Number : 361-853-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2018
Last Update Date : 10/16/2018

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Directions to “ HAJRA MUJTABA DMD” Practice Location

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