MEDICARE: ALI POURHAGHI DDS PA

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	18308	TX

General Provider Information

NPI Number	:	1366560021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI POURHAGHI DDS PA

Provider Business Mailing Address
First Line	:	4704 AIRLINE DR STE A-1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3004
Country	:	US
Telephone Number	:	713-695-1400
Fax Number	:	713-695-0070

Provider Business Practice Location Address
First Line	:	4704 AIRLINE DR STE A-1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3004
Country	:	US
Telephone Number	:	713-695-1400
Fax Number	:	713-695-0070

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ALI POURHAGHI
Credential	:	DDS
Telephone Number	:	713-695-1400

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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