Provider Demographics
NPI:1609538669
Name:MAHMMOD, TAKTM
Entity Type:Individual
Prefix:
First Name:TAKTM
Middle Name:
Last Name:MAHMMOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16818 BENWICK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7100
Mailing Address - Country:US
Mailing Address - Phone:832-248-7318
Mailing Address - Fax:
Practice Address - Street 1:9824 FONDREN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3648
Practice Address - Country:US
Practice Address - Phone:713-271-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist