Provider Demographics
NPI:1912159054
Name:PRISTINE DENTAL P.L.L.C
Entity Type:Organization
Organization Name:PRISTINE DENTAL P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:713-665-7707
Mailing Address - Street 1:9150 MAIN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3843
Mailing Address - Country:US
Mailing Address - Phone:713-665-7707
Mailing Address - Fax:
Practice Address - Street 1:9150 MAIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3843
Practice Address - Country:US
Practice Address - Phone:713-665-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty