Provider Demographics
NPI:1275698441
Name:NIKNAM, BEHROOZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEHROOZ
Middle Name:
Last Name:NIKNAM
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 1:2704 CROSS TIMBERS RD
Mailing Address - Street 2:ST. 108
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2705
Mailing Address - Country:US
Mailing Address - Phone:972-874-1890
Mailing Address - Fax:972-874-0839
Practice Address - Street 1:2704 CROSS TIMBERS RD
Practice Address - Street 2:ST. 108
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2705
Practice Address - Country:US
Practice Address - Phone:972-874-1890
Practice Address - Fax:972-874-0839
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice