Provider Demographics
NPI:1073613519
Name:MIRMOHAMMADI, MOHAMMAD HOSSEIN (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD HOSSEIN
Middle Name:
Last Name:MIRMOHAMMADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6104
Mailing Address - Country:US
Mailing Address - Phone:956-631-5700
Mailing Address - Fax:956-631-1717
Practice Address - Street 1:801 E NOLANA ST
Practice Address - Street 2:SUITE 21
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6104
Practice Address - Country:US
Practice Address - Phone:956-631-5700
Practice Address - Fax:956-631-1717
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist