Provider Demographics
NPI:1922428747
Name:MADANI, MOJTABA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJTABA
Middle Name:
Last Name:MADANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 S EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3222
Mailing Address - Country:US
Mailing Address - Phone:956-465-0698
Mailing Address - Fax:
Practice Address - Street 1:1208 S EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3222
Practice Address - Country:US
Practice Address - Phone:956-465-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-19
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice