Provider Demographics
NPI:1619396066
Name:WESTOVER HILLS FAMILY DENTAL CARE, LP
Entity Type:Organization
Organization Name:WESTOVER HILLS FAMILY DENTAL CARE, LP
Other - Org Name:WH FAMILY DENTAL CARE, LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADDOUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-927-1400
Mailing Address - Street 1:11212 STATE HIGHWAY 151
Mailing Address - Street 2:STE # 209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4498
Mailing Address - Country:US
Mailing Address - Phone:210-927-1400
Mailing Address - Fax:210-927-6330
Practice Address - Street 1:11212 STATE HIGHWAY 151
Practice Address - Street 2:STE # 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-927-1400
Practice Address - Fax:210-927-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1363434-11Medicaid