Provider Demographics
NPI:1477065969
Name:MOHAMMED SUBHANI PA
Entity Type:Organization
Organization Name:MOHAMMED SUBHANI PA
Other - Org Name:RGV PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SUBHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-749-0974
Mailing Address - Street 1:705 WISTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2839
Mailing Address - Country:US
Mailing Address - Phone:210-749-0974
Mailing Address - Fax:
Practice Address - Street 1:1601 W. TRENTON
Practice Address - Street 2:SUITE J
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:210-749-0974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270361223G0001X
TX279101223P0221X
TX222381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty