Provider Demographics
NPI:1275054389
Name:RAYYAN, AHMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:RAYYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NW LOOP 410 STE 455
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5511
Mailing Address - Country:US
Mailing Address - Phone:210-342-2444
Mailing Address - Fax:
Practice Address - Street 1:601 NW LOOP 410 STE 455
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5511
Practice Address - Country:US
Practice Address - Phone:210-342-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331911223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223E0200XDental ProvidersDentistEndodontics