Provider Demographics
NPI:1295250785
Name:MINALI CORPORATION
Entity type:Organization
Organization Name:MINALI CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABATABAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-563-2478
Mailing Address - Street 1:5210 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5543
Mailing Address - Country:US
Mailing Address - Phone:832-563-2478
Mailing Address - Fax:
Practice Address - Street 1:7700 FULTON ST STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3642
Practice Address - Country:US
Practice Address - Phone:832-422-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty