Provider Demographics
NPI:1154971554
Name:AZMA AHMED PLLC
Entity type:Organization
Organization Name:AZMA AHMED PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-706-7057
Mailing Address - Street 1:1116 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-5318
Mailing Address - Country:US
Mailing Address - Phone:903-340-8540
Mailing Address - Fax:903-340-8543
Practice Address - Street 1:1116 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5318
Practice Address - Country:US
Practice Address - Phone:903-340-8540
Practice Address - Fax:903-340-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty