Provider Demographics
NPI:1205473139
Name:AHMED, MAHDIYA I (DDS)
Entity type:Individual
Prefix:
First Name:MAHDIYA
Middle Name:I
Last Name:AHMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5257
Mailing Address - Country:US
Mailing Address - Phone:917-535-0573
Mailing Address - Fax:
Practice Address - Street 1:2831 W 15TH ST # 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7527
Practice Address - Country:US
Practice Address - Phone:972-360-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist