Provider Demographics
NPI:1265595961
Name:YAMANI, MUSTAFA QAMARUDDIN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:QAMARUDDIN
Last Name:YAMANI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MUSTAFA
Other - Middle Name:QAMARALI
Other - Last Name:YAMANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:23607 KELLY JOE SMITH ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-8405
Mailing Address - Country:US
Mailing Address - Phone:832-760-8630
Mailing Address - Fax:
Practice Address - Street 1:23607 KELLY JOE SMITH ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-8405
Practice Address - Country:US
Practice Address - Phone:832-760-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice