Provider Demographics
NPI:1790107159
Name:NEENAH PLAZA DENTISTRY
Entity Type:Organization
Organization Name:NEENAH PLAZA DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIBZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-388-1833
Mailing Address - Street 1:9900 W PARMER LN
Mailing Address - Street 2:STE A205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4909
Mailing Address - Country:US
Mailing Address - Phone:512-388-1833
Mailing Address - Fax:
Practice Address - Street 1:9900 W PARMER LN
Practice Address - Street 2:STE A205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4909
Practice Address - Country:US
Practice Address - Phone:512-388-1833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty