Provider Demographics
NPI:1881947448
Name:AAVA DENTAL IRVING PLLC
Entity type:Organization
Organization Name:AAVA DENTAL IRVING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARRABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-653-9799
Mailing Address - Street 1:2450 N BELT LINE RD
Mailing Address - Street 2:110
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5241
Mailing Address - Country:US
Mailing Address - Phone:817-529-8151
Mailing Address - Fax:817-529-8156
Practice Address - Street 1:2450 N BELT LINE RD
Practice Address - Street 2:110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5241
Practice Address - Country:US
Practice Address - Phone:817-529-8151
Practice Address - Fax:817-529-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X, 1223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193443219Medicaid
TX193443222Medicaid
TX193443220Medicaid
TX193443223Medicaid
TX193443218Medicaid
TX193443221Medicaid