Healthcare Provider Details

I. General information

NPI: 1124499967
Provider Name (Legal Business Name): BNS DENTIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 BELLAIRE BLVD BLDG 4
BELLAIRE TX
77401-3957
US

IV. Provider business mailing address

5420 BELLAIRE BLVD BLDG 4
BELLAIRE TX
77401-3957
US

V. Phone/Fax

Practice location:
  • Phone: 713-432-0900
  • Fax:
Mailing address:
  • Phone: 713-432-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21389
License Number StateTX

VIII. Authorized Official

Name: BABAK GORAVANCHI
Title or Position: OWNER
Credential: DDS
Phone: 713-446-8547