Provider Demographics
NPI:1891217949
Name:AHMAD, MARIAM (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIAM
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAYED
Mailing Address - Street 1:303 AMBROSE DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4904
Mailing Address - Country:US
Mailing Address - Phone:512-734-7271
Mailing Address - Fax:
Practice Address - Street 1:303 AMBROSE DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4904
Practice Address - Country:US
Practice Address - Phone:512-734-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002032971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN00203297Medicaid
CO1891217949Medicaid