Provider Demographics
NPI:1689879025
Name:POURNIK, HEDIEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEDIEH
Middle Name:
Last Name:POURNIK
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 1:23741 HIGHWAY 59 STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5393
Mailing Address - Country:US
Mailing Address - Phone:281-354-1197
Mailing Address - Fax:281-354-2691
Practice Address - Street 1:23741 HIGHWAY 59
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5388
Practice Address - Country:US
Practice Address - Phone:281-354-1197
Practice Address - Fax:281-354-2691
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist