Provider Demographics
NPI:1366673659
Name:HOSSEINI, IRAN
Entity Type:Individual
Prefix:
First Name:IRAN
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 PRINCE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4183
Mailing Address - Country:US
Mailing Address - Phone:832-932-5091
Mailing Address - Fax:832-932-5091
Practice Address - Street 1:3234 PRINCE GEORGE DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4183
Practice Address - Country:US
Practice Address - Phone:832-932-5091
Practice Address - Fax:832-932-5091
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice