Provider Demographics
NPI:1760515571
Name:BAHRAMIPOUR, MEHRDAD
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:BAHRAMIPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 SAN FELIPE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1628
Mailing Address - Country:US
Mailing Address - Phone:713-952-3434
Mailing Address - Fax:713-952-8129
Practice Address - Street 1:7745 SAN FELIPE ST STE 111
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1628
Practice Address - Country:US
Practice Address - Phone:713-952-3434
Practice Address - Fax:713-952-8129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice