Provider Demographics
NPI:1073628772
Name:ATABAKHSH, HAMID (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:ATABAKHSH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 LOUETTA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4785
Mailing Address - Country:US
Mailing Address - Phone:281-288-7140
Mailing Address - Fax:281-288-4924
Practice Address - Street 1:2525 LOUETTA RD STE 101
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4785
Practice Address - Country:US
Practice Address - Phone:281-288-7140
Practice Address - Fax:281-288-4924
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147860401Medicaid