Provider Demographics
NPI:1649652793
Name:AHMED, TAYYABA S (DDS)
Entity type:Individual
Prefix:DR
First Name:TAYYABA
Middle Name:S
Last Name:AHMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 VERDE CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5691
Mailing Address - Country:US
Mailing Address - Phone:630-639-1283
Mailing Address - Fax:
Practice Address - Street 1:2730 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8780
Practice Address - Country:US
Practice Address - Phone:214-586-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372981223G0001X, 1223D0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821875790OtherNPPES
TX472622601Medicaid