Provider Demographics
NPI:1013918143
Name:ZAREI, MANSOUR M (DDS)
Entity Type:Individual
Prefix:
First Name:MANSOUR
Middle Name:M
Last Name:ZAREI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:830-608-5770
Practice Address - Street 1:256 S KRUEGER AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6941
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:830-608-5770
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice