Provider Demographics
NPI:1083331367
Name:HOOSHYAR, HANIEH
Entity Type:Individual
Prefix:DR
First Name:HANIEH
Middle Name:
Last Name:HOOSHYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 GRAVEL HILL ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6971
Mailing Address - Country:US
Mailing Address - Phone:901-338-1085
Mailing Address - Fax:
Practice Address - Street 1:6395 S MCCARRAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6101
Practice Address - Country:US
Practice Address - Phone:775-823-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist