Provider Demographics
NPI:1194435735
Name:ORCHID DENTISTRY PLLC
Entity type:Organization
Organization Name:ORCHID DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:MOHD
Authorized Official - Last Name:RABATA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-589-5260
Mailing Address - Street 1:2209 LIGHTHOUSE LAKE LN
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-1946
Mailing Address - Country:US
Mailing Address - Phone:832-589-5260
Mailing Address - Fax:
Practice Address - Street 1:1702 RODD FIELD RD STE 102&103
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5027
Practice Address - Country:US
Practice Address - Phone:361-600-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty