Provider Demographics
NPI:1639587058
Name:MEDIDENT HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:MEDIDENT HEALTHCARE ASSOCIATES
Other - Org Name:EHSAN ARABZADEH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARABZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FICOI
Authorized Official - Phone:281-440-0050
Mailing Address - Street 1:607 TIMBERDALE LN
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3049
Mailing Address - Country:US
Mailing Address - Phone:281-440-0050
Mailing Address - Fax:281-866-0403
Practice Address - Street 1:607 TIMBERDALE LN
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3049
Practice Address - Country:US
Practice Address - Phone:281-440-0050
Practice Address - Fax:281-866-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17246302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization