Provider Demographics
NPI:1750980025
Name:HANI TABAEI ZAVAREH, NEDA
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:HANI TABAEI ZAVAREH
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 1:10900 TWISTED ELM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2369
Mailing Address - Country:US
Mailing Address - Phone:415-636-0304
Mailing Address - Fax:
Practice Address - Street 1:10900 TWISTED ELM DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-2369
Practice Address - Country:US
Practice Address - Phone:415-636-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122941122300000X
TX367851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist