Provider Demographics
NPI:1578987475
Name:TEXAS PREMIER DENTAL - SPRING BRANCH, PLLC
Entity Type:Organization
Organization Name:TEXAS PREMIER DENTAL - SPRING BRANCH, PLLC
Other - Org Name:AYM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIASGAR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOGRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-984-1115
Mailing Address - Street 1:17330 SPRING CYPRESS RD STE 115
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4294
Mailing Address - Country:US
Mailing Address - Phone:281-256-3222
Mailing Address - Fax:281-256-0629
Practice Address - Street 1:2030 N. GESSNER RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-6342
Practice Address - Country:US
Practice Address - Phone:713-984-1115
Practice Address - Fax:713-984-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty