Provider Demographics
NPI:1952454621
Name:JAHANBIN, ALI Z (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:Z
Last Name:JAHANBIN
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 1:810 CALDWELL ST
Mailing Address - Street 2:BUILDING A, SUITE 300
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3360
Mailing Address - Country:US
Mailing Address - Phone:512-272-8900
Mailing Address - Fax:512-272-8915
Practice Address - Street 1:810 CALDWELL ST
Practice Address - Street 2:BUILDING A, SUITE 300
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3360
Practice Address - Country:US
Practice Address - Phone:512-272-8900
Practice Address - Fax:512-272-8915
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179956101Medicaid
TX174254601Medicaid