Provider Demographics
NPI:1275857674
Name:REZAPOUR, MONA (DMD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:REZAPOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MANCHACA RD APT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6082
Mailing Address - Country:US
Mailing Address - Phone:702-232-6551
Mailing Address - Fax:
Practice Address - Street 1:1700 W PARMER LN STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4609
Practice Address - Country:US
Practice Address - Phone:702-232-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics