Provider Demographics
NPI:1467002303
Name:SHAHANGIAN, IDEAN
Entity Type:Individual
Prefix:DR
First Name:IDEAN
Middle Name:
Last Name:SHAHANGIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4899 MONTROSE BLVD APT 1708
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6171
Mailing Address - Country:US
Mailing Address - Phone:949-500-7987
Mailing Address - Fax:
Practice Address - Street 1:3500 LITTLE YORK RD STE A1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-3600
Practice Address - Country:US
Practice Address - Phone:713-766-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist