Provider Demographics
NPI:1851441364
Name:AHMADI, MAHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHIN
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5821
Mailing Address - Country:US
Mailing Address - Phone:281-422-8268
Mailing Address - Fax:281-837-6100
Practice Address - Street 1:1105 E JAMES ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-5821
Practice Address - Country:US
Practice Address - Phone:281-422-8268
Practice Address - Fax:281-837-6100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92522OtherUNITED HEALTHCARE
TXD19145OtherBLUE CROSS BLUE SHIELD
TX1411801OtherUNITED CONCORDIA
TXG60409 01OtherTEXAS CHIP PROGRAM