Provider Demographics
NPI:1821520834
Name:HAROUNPOUR, SANAZ (DDS)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:HAROUNPOUR
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 1:6565 MCCALLUM BLVD APT 343
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-7020
Mailing Address - Country:US
Mailing Address - Phone:310-663-5927
Mailing Address - Fax:
Practice Address - Street 1:1800 BOMAR ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6728
Practice Address - Country:US
Practice Address - Phone:903-938-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty