Provider Demographics
NPI:1275274060
Name:KEIVANI, MEISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEISA
Middle Name:
Last Name:KEIVANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 SOUTHERN MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3672
Mailing Address - Country:US
Mailing Address - Phone:469-867-5171
Mailing Address - Fax:
Practice Address - Street 1:7500 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:469-867-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist