Provider Demographics
NPI:1336316637
Name:ALETAHA, SHOKOOH SADAT (DDS)
Entity Type:Individual
Prefix:
First Name:SHOKOOH
Middle Name:SADAT
Last Name:ALETAHA
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 1:14228 MIDWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3702
Mailing Address - Country:US
Mailing Address - Phone:214-232-4482
Mailing Address - Fax:972-852-1111
Practice Address - Street 1:14228 MIDWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3702
Practice Address - Country:US
Practice Address - Phone:972-852-2222
Practice Address - Fax:972-852-1111
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice