Basic Information
| Provider Information | |||||||||
| NPI: | 1790110328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IQBAL | ||||||||
| FirstName: | SAMI | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7838 HUEBNER RD | ||||||||
| Address2: | APT# 5304 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782403167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474983710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2316 S ZAPATA HWY | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780466563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562840600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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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 | 29438 | TX | Y | Dental Providers | Dentist | General Practice | 1223P0221X | 29438 | TX | N | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.