MEDICARE: ALI REZA MERMAR PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1629840103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI REZA MERMAR PLLC

Provider Business Mailing Address
First Line	:	13327 OLIVE TRCE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2253
Country	:	US
Telephone Number	:	832-715-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	8710 GRAND MISSION BLVD STE A
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-5413
Country	:	US
Telephone Number	:	832-715-0552
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ALI REZA MEMAR
Credential	:	DMD
Telephone Number	:	832-715-0552

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	10/26/2023

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Directions to “ALI REZA MERMAR PLLC ” Practice Location

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