MEDICARE: DR. ENAYAT ERIC ASTANI D.D.S.

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	122300000X	Dentist	60907	KS
2	1223P0221X	Pediatric Dentistry	26032	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	:	1982858981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENAYAT ERIC ASTANI D.D.S.

Provider Business Mailing Address
First Line	:	2887 S RICHEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-7215
Country	:	US
Telephone Number	:	832-831-5173
Fax Number	:

Provider Business Practice Location Address
First Line	:	2887 SOUTH RICHEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098
Country	:	US
Telephone Number	:	832-831-5173
Fax Number	:

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	10/11/2018

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