Provider Demographics
NPI:1821211798
Name:BAGHERPOUR, MAHNAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:
Last Name:BAGHERPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAHNAZ
Other - Middle Name:
Other - Last Name:BAGHERPOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7112 ED BLUESTEIN BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2924
Mailing Address - Country:US
Mailing Address - Phone:512-926-7001
Mailing Address - Fax:512-926-7040
Practice Address - Street 1:7112 ED BLUESTEIN BLVD STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2924
Practice Address - Country:US
Practice Address - Phone:512-926-7001
Practice Address - Fax:512-926-7040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice