Individual provider Active NPI

Habib Ali Rahemtulla, DDS

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1073005476
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
38112 Issued in TX
Practice address
2810 Nacogdoches Rd
San Antonio, TX 78217-5827
Phone
(210) 828-9644
Fax
(210) 828-9646
NPI assigned
May 31, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 1001841-15 WI
General Practice Dentistry 1223G0001X 38112 TX Primary

Addresses

Primary practice location

2810 Nacogdoches Rd
San Antonio, TX 78217-5827

Mailing address

2810 Nacogdoches Rd
San Antonio, TX 78217-5827
Phone (210) 828-9644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1001841-15WIMDDentist
38112TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
R&J Dental, PLLC General Practice CurrentSince Jun 9, 2024 Accepting new patients
G Dental, LLC General Practice Past Accepting new patients
Donna Clark-Hagy D.D.S. and Anthony J. Mitchell D.D.S. Dentist PastSince Jan 1, 2023 Accepting new patients

Locations

2810 Nacogdoches Rd
San Antonio, TX 78217
Phone (210) 818-2810

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1073005476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 NACOGDOCHES RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175827",
            "telephone_number": "210-828-9644",
            "fax_number": "210-828-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 NACOGDOCHES RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175827",
            "telephone_number": "210-828-9644",
            "fax_number": "210-828-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHEMTULLA",
        "first_name": "HABIB",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001841-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "38112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.