MEDICARE: MINA TABATABAI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN1001270	DC
2	1223G0001X	General Practice Dentistry	15451	MD
3	1223P0221X	Pediatric Dentistry	29859	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225470206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA TABATABAI DDS

Provider Business Mailing Address
First Line	:	5210 SAXON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-5543
Country	:	US
Telephone Number	:	727-515-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 FULTON ST STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3642
Country	:	US
Telephone Number	:	832-422-5792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	05/10/2018

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Directions to “ MINA TABATABAI DDS” Practice Location

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