Provider Demographics
NPI:1174256846
Name:MEHMANDOOST, ALIREZA SHAYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:SHAYAN
Last Name:MEHMANDOOST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 CANYON RUN CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7098
Mailing Address - Country:US
Mailing Address - Phone:281-829-7094
Mailing Address - Fax:
Practice Address - Street 1:31315 FM 2920 RD STE 16A
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8022
Practice Address - Country:US
Practice Address - Phone:936-372-2673
Practice Address - Fax:936-372-5199
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX393831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice