Haidar Imam, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

41045 Issued in TX

Practice address

10538 Potranco Rd Ste 206
San Antonio, TX 78251-3359

Phone

(210) 469-4235

NPI assigned

Mar 10, 2023

Last updated

Oct 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Potranco Dentistry, PC

  dba Potranco Dentistry

  • Dentist
  • San Antonio, TX
  • NPI 1922653518
  NPD

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

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1154022838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10538 POTRANCO RD STE 206",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782513359",
            "telephone_number": "281-224-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10538 POTRANCO RD STE 206",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782513359",
            "telephone_number": "210-469-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAM",
        "first_name": "HAIDAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-10",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "41045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Imagdent
• Imagdent San Antonio LLC (iMagDent San Antonio)
• Imagine Counseling LLC
• Imagine Therapies, LLC
• Imaging Partners of San Antonio, LLLP (The Imaging Centre at the Quarry)
• Mohamed Imam, DDS
• Erin Imburgia
• Imed Healthcare Associates, PLLC (IMED Internal Medicine)
• Imed Internal Medicine PA
• Img Clinic PLLC

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.