Provider Demographics
NPI:1396024287
Name:MAHIN AHMADI DDS
Entity Type:Organization
Organization Name:MAHIN AHMADI DDS
Other - Org Name:BAYTOWN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-422-8268
Mailing Address - Street 1:1105 E JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5821
Mailing Address - Country:US
Mailing Address - Phone:281-422-8268
Mailing Address - Fax:281-837-6100
Practice Address - Street 1:1105 E JAMES ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-5821
Practice Address - Country:US
Practice Address - Phone:281-422-8268
Practice Address - Fax:281-837-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25536122300000X
TX191451223G0001X
TX251091223G0001X
TX252571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160865501Medicaid