Provider Demographics
NPI:1659716090
Name:ALTUS DENTAL CARE, PA
Entity Type:Organization
Organization Name:ALTUS DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POORANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-447-7220
Mailing Address - Street 1:410 W LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1305
Mailing Address - Country:US
Mailing Address - Phone:281-447-7220
Mailing Address - Fax:281-447-7221
Practice Address - Street 1:4508 GARTH RD
Practice Address - Street 2:SUITE #A
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2154
Practice Address - Country:US
Practice Address - Phone:281-427-5100
Practice Address - Fax:713-583-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty