Provider Demographics
NPI:1497253231
Name:MEMAR ARDESTANI, PEGAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEGAH
Middle Name:
Last Name:MEMAR ARDESTANI
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 1:2111 WESTHEIMER RD APT 2114
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1788
Mailing Address - Country:US
Mailing Address - Phone:713-933-4036
Mailing Address - Fax:
Practice Address - Street 1:3902 N FRY RD STE C
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6840
Practice Address - Country:US
Practice Address - Phone:281-945-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist