Provider Demographics
NPI:1952693970
Name:KHALESSEH, NILOOFAR (DDS)
Entity Type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:KHALESSEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 PRESTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2450
Mailing Address - Country:US
Mailing Address - Phone:972-666-4949
Mailing Address - Fax:972-666-4944
Practice Address - Street 1:19200 PRESTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2450
Practice Address - Country:US
Practice Address - Phone:972-666-4949
Practice Address - Fax:972-666-4944
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry