Provider Demographics
NPI:1821827775
Name:ANSARI, KAMRAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 LUCKY LEMON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3366
Mailing Address - Country:US
Mailing Address - Phone:615-734-9252
Mailing Address - Fax:
Practice Address - Street 1:5110 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2014
Practice Address - Country:US
Practice Address - Phone:832-595-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX408681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice