Provider Demographics
NPI:1205417201
Name:IMRAN, HAIDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAIDER
Middle Name:
Last Name:IMRAN
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 1:25222 AUBURN BEND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4342
Mailing Address - Country:US
Mailing Address - Phone:832-403-0502
Mailing Address - Fax:
Practice Address - Street 1:24230 KUYKENDAHL RD STE 300
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5125
Practice Address - Country:US
Practice Address - Phone:281-255-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX374441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35725228OtherTEXAS DRIVER'S LICENSE