Provider Demographics
NPI:1013205715
Name:PAYMON PAHLAVAN, DDS, PA
Entity Type:Organization
Organization Name:PAYMON PAHLAVAN, DDS, PA
Other - Org Name:SMILE BARN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-850-2900
Mailing Address - Street 1:8502 WYNDHAM CT
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1138
Mailing Address - Country:US
Mailing Address - Phone:281-850-2900
Mailing Address - Fax:
Practice Address - Street 1:10815 VETERANS MEMORIAL DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-3845
Practice Address - Country:US
Practice Address - Phone:281-850-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty