Provider Demographics
NPI:1669751434
Name:MASID LLC
Entity type:Organization
Organization Name:MASID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDRISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-257-8815
Mailing Address - Street 1:7809 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7007
Mailing Address - Country:US
Mailing Address - Phone:281-257-8815
Mailing Address - Fax:281-257-6267
Practice Address - Street 1:7809 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7007
Practice Address - Country:US
Practice Address - Phone:281-257-8815
Practice Address - Fax:281-257-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17900302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization