Provider Demographics
NPI:1982287397
Name:RAYETPARVAR, ROUJAU
Entity Type:Individual
Prefix:
First Name:ROUJAU
Middle Name:
Last Name:RAYETPARVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W LOVERS LN STE 109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-7115
Mailing Address - Country:US
Mailing Address - Phone:214-207-2800
Mailing Address - Fax:
Practice Address - Street 1:5757 W LOVERS LN STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-7115
Practice Address - Country:US
Practice Address - Phone:469-715-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX400591223G0001X
CA107774122300000X
NY062677122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program