Provider Demographics
NPI:1235323528
Name:BOHLULI, PEDRAM (DDS,MS, PHD)
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:BOHLULI
Suffix:
Gender:M
Credentials:DDS,MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3414
Mailing Address - Country:US
Mailing Address - Phone:713-932-7730
Mailing Address - Fax:713-932-7244
Practice Address - Street 1:9400 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3414
Practice Address - Country:US
Practice Address - Phone:713-932-7730
Practice Address - Fax:713-932-7244
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562001223E0200X
TX234691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics