Provider Demographics
NPI:1811613169
Name:EBRAHIMI, HOURDAD (DMD)
Entity type:Individual
Prefix:
First Name:HOURDAD
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 MARBACH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1981
Mailing Address - Country:US
Mailing Address - Phone:210-538-8206
Mailing Address - Fax:
Practice Address - Street 1:9819 MARBACH RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1981
Practice Address - Country:US
Practice Address - Phone:210-538-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice