Provider Demographics
NPI:1992280168
Name:SHARAF, AHMED (DDS)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:SHARAF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 DOMAIN BLVD APT 3549
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-0057
Mailing Address - Country:US
Mailing Address - Phone:954-651-1254
Mailing Address - Fax:
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 212A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7002
Practice Address - Country:US
Practice Address - Phone:954-651-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice