Provider Demographics
NPI:1225524408
Name:GOLBANDI, POUYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:POUYA
Middle Name:
Last Name:GOLBANDI
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 1:15851 DALLAS PKWY STE 306,#444
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6313
Mailing Address - Country:US
Mailing Address - Phone:469-231-4887
Mailing Address - Fax:
Practice Address - Street 1:15851 DALLAS PKWY STE 306,#444
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6313
Practice Address - Country:US
Practice Address - Phone:469-231-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist