Provider Demographics
NPI:1659749075
Name:LA PORTE FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:LA PORTE FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-542-9772
Mailing Address - Street 1:8401 W FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4418
Mailing Address - Country:US
Mailing Address - Phone:281-542-9772
Mailing Address - Fax:281-542-9774
Practice Address - Street 1:8401 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4418
Practice Address - Country:US
Practice Address - Phone:281-542-9772
Practice Address - Fax:281-542-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty