Provider Demographics
NPI:1023681368
Name:NAWAZ, AHMAD
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:NAWAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MENEFEE ST STE C
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3713
Mailing Address - Country:US
Mailing Address - Phone:859-693-3962
Mailing Address - Fax:
Practice Address - Street 1:166 MENEFEE ST STE C
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3713
Practice Address - Country:US
Practice Address - Phone:859-693-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice