Provider Demographics
NPI:1497316517
Name:MOMIN, REHMAN
Entity Type:Individual
Prefix:
First Name:REHMAN
Middle Name:
Last Name:MOMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17904 CRYSTAL CV
Mailing Address - Street 2:
Mailing Address - City:JONESTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4429
Mailing Address - Country:US
Mailing Address - Phone:512-785-7477
Mailing Address - Fax:
Practice Address - Street 1:2020 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1305
Practice Address - Country:US
Practice Address - Phone:210-349-3368
Practice Address - Fax:210-349-2473
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice