Provider Demographics
NPI:1750774121
Name:NOLANA FAMILY DENTAL, PA
Entity type:Organization
Organization Name:NOLANA FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MIRMOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-655-0067
Mailing Address - Street 1:801 E NOLANA AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6106
Mailing Address - Country:US
Mailing Address - Phone:956-631-5700
Mailing Address - Fax:956-631-1717
Practice Address - Street 1:801 E NOLANA AVE STE 21
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6106
Practice Address - Country:US
Practice Address - Phone:956-631-5700
Practice Address - Fax:956-631-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073613519OtherINDIVIDUAL NPI