Provider Demographics
NPI:1083404073
Name:AHMED MANASSRA DMD PC
Entity type:Organization
Organization Name:AHMED MANASSRA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MANASSRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-913-5946
Mailing Address - Street 1:841 BLOSSOM HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2708
Mailing Address - Country:US
Mailing Address - Phone:408-809-7760
Mailing Address - Fax:
Practice Address - Street 1:841 BLOSSOM HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2708
Practice Address - Country:US
Practice Address - Phone:408-809-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental