Provider Demographics
NPI:1023531407
Name:AHMED, AZHAR (DDS)
Entity type:Individual
Prefix:
First Name:AZHAR
Middle Name:
Last Name:AHMED
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 1:311 N DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-5519
Mailing Address - Country:US
Mailing Address - Phone:1806-893-9897
Mailing Address - Fax:806-870-5559
Practice Address - Street 1:311 N DALLAS AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-5519
Practice Address - Country:US
Practice Address - Phone:806-870-5555
Practice Address - Fax:806-870-5559
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33326OtherLICENSE