Provider Demographics
NPI:1053579771
Name:MILLWALA, AHMAD ALI (DMD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:ALI
Last Name:MILLWALA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16226 PINON VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-7196
Mailing Address - Country:US
Mailing Address - Phone:773-732-8288
Mailing Address - Fax:
Practice Address - Street 1:6155 FRY RD STE 600
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5563
Practice Address - Country:US
Practice Address - Phone:281-667-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0548761223G0001X
KY86111223G0001X
OH30.0238771223S0112X
TX307591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice