Provider Demographics
NPI:1659036911
Name:RAZA, SYED AHSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:AHSAN
Last Name:RAZA
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 1:2938 MONTROSE TRL
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1906
Mailing Address - Country:US
Mailing Address - Phone:615-968-1803
Mailing Address - Fax:
Practice Address - Street 1:2127 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4400
Practice Address - Country:US
Practice Address - Phone:903-392-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice