Provider Demographics
NPI:1912132747
Name:ALIREZAEI, BEHROUZ (DDSPA)
Entity Type:Individual
Prefix:DR
First Name:BEHROUZ
Middle Name:
Last Name:ALIREZAEI
Suffix:
Gender:M
Credentials:DDSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3544
Mailing Address - Country:US
Mailing Address - Phone:281-277-1545
Mailing Address - Fax:281-277-1573
Practice Address - Street 1:50 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:713-772-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ24488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist