Provider Demographics
NPI:1659864254
Name:HEMMATIAN, MOHAMMAD
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:HEMMATIAN
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 1:8210 CAROLINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1104
Mailing Address - Country:US
Mailing Address - Phone:703-340-9342
Mailing Address - Fax:
Practice Address - Street 1:8455 FANNIN ST STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4805
Practice Address - Country:US
Practice Address - Phone:703-340-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist