Basic Information
| Provider Information | |||||||||
| NPI: | 1760677710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHRAFI | ||||||||
| FirstName: | MUJIB | ||||||||
| MiddleName: | MUQUIM | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 FARRAH LN | ||||||||
| Address2: | 1015 | ||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774774589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168785624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5357 W BELLFORT ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770353001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137233777 | ||||||||
| FaxNumber: | 7137236018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 23546 | TX | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 192171002 | 05 | TX | MEDICAID |