Healthcare Provider Details

I. General information

NPI: 1245930890
Provider Name (Legal Business Name): HOSSEIN MEMARPOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 LBJ FWY STE 1700
DALLAS TX
75234-2759
US

IV. Provider business mailing address

3030 LBJ FWY STE 1700
DALLAS TX
75234-2759
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41740
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: