Healthcare Provider Details

I. General information

NPI: 1730429481
Provider Name (Legal Business Name): JINOUS FERDOUSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S PRESTON RD STE 70
PROSPER TX
75078-3531
US

IV. Provider business mailing address

900 S PRESTON RD STE 70
PROSPER TX
75078-3531
US

V. Phone/Fax

Practice location:
  • Phone: 469-631-3484
  • Fax:
Mailing address:
  • Phone: 469-631-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: