Active NPI
Tab R Imdacha, DDS
- Dentist
- Houston, TX
National Provider Identifier
1710342902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31602
- Practice address
- 1885 El Paseo St
Apt 813
Houston, TX 77054-3089 - Phone
- (512) 350-0760
- NPI assigned
- Dec 15, 2015
- Last updated
- Dec 15, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 31602 | TX | Primary |
Addresses
Primary practice location
1885 El Paseo St
Apt 813
Houston, TX 77054-3089
Mailing address
1885 El Paseo St
Apt 813
Houston, TX 77054-3089
Phone (512) 350-0760
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
| License | State | Type | Specialty |
|---|---|---|---|
| 31602 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1710342902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1885 EL PASEO ST",
"address_2": "APT 813",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770543089",
"telephone_number": "512-350-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1885 EL PASEO ST",
"address_2": "APT 813",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770543089",
"telephone_number": "512-350-0760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMDACHA",
"first_name": "TAB",
"middle_name": "R",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-15",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.