Provider Demographics
NPI:1497324719
Name:MOHAMMED, USMAN (DMD)
Entity Type:Individual
Prefix:
First Name:USMAN
Middle Name:
Last Name:MOHAMMED
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 1:6914 FM 78 # 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1771
Mailing Address - Country:US
Mailing Address - Phone:210-892-8484
Mailing Address - Fax:
Practice Address - Street 1:6914 FM 78 # 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1771
Practice Address - Country:US
Practice Address - Phone:210-892-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77561223G0001X
390200000X
TX380021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program