Healthcare Provider Details

I. General information

NPI: 1962620492
Provider Name (Legal Business Name): NEGAR ESLAMI DDS,FAGD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 6TH ST SUITE #365
AUSTIN TX
78703-4773
US

IV. Provider business mailing address

1717 W 6TH ST SUITE #365
AUSTIN TX
78703-4773
US

V. Phone/Fax

Practice location:
  • Phone: 512-482-9383
  • Fax: 512-320-0064
Mailing address:
  • Phone: 512-482-9383
  • Fax: 512-320-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: