Provider Demographics
NPI:1619159209
Name:KAZEMYAN, SOUZAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOUZAN
Middle Name:
Last Name:KAZEMYAN
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 1:9150 SOUTH MAIN ST.
Mailing Address - Street 2:SUITE I
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025
Mailing Address - Country:US
Mailing Address - Phone:713-665-7707
Mailing Address - Fax:
Practice Address - Street 1:9150 SOUTH MAIN ST.
Practice Address - Street 2:SUITE I
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-665-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice