Provider Demographics
NPI:1720554843
Name:MUJTABA, HAJRA (DMD)
Entity Type:Individual
Prefix:
First Name:HAJRA
Middle Name:
Last Name:MUJTABA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 TIMBERGATE DR APT 608
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3184
Mailing Address - Country:US
Mailing Address - Phone:617-870-1406
Mailing Address - Fax:
Practice Address - Street 1:4224 AYERS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5317
Practice Address - Country:US
Practice Address - Phone:361-853-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice