Provider Demographics
NPI:1982830543
Name:HOUSHIAR, MONA
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:HOUSHIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SAGE RD
Mailing Address - Street 2:APT #1441
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6317
Mailing Address - Country:US
Mailing Address - Phone:310-994-7567
Mailing Address - Fax:
Practice Address - Street 1:3000 SAGE STREET
Practice Address - Street 2:APT # 1441
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:310-994-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A1223G0001X
TX289461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice