Provider Demographics
NPI:1952032195
Name:MOUSAVI, SHAHLA (DDS)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:MOUSAVI
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 1:1111 DURHAM DR APT 335
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6422
Mailing Address - Country:US
Mailing Address - Phone:832-887-9698
Mailing Address - Fax:
Practice Address - Street 1:9727 BARKER CYPRESS RD STE 600
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4445
Practice Address - Country:US
Practice Address - Phone:281-861-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice