Provider Demographics
NPI:1801205216
Name:ALTUS DENTAL SURGERY HOUSTON, PA
Entity Type:Organization
Organization Name:ALTUS DENTAL SURGERY HOUSTON, PA
Other - Org Name:ALTUS DENTAL SURGERY CENTER HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POORANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-427-5100
Mailing Address - Street 1:4508 GARTH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9901 TOWN PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2343
Practice Address - Country:US
Practice Address - Phone:281-427-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty