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General NPI Number Information
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NPI Number | 1225470206
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Entity Type | Individual
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Provider Name | MINA TABATABAI DDS
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 7700 FULTON ST STE A
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City | HOUSTON
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State | TX
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Zip | 77022-3642
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Country | US
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Telephone | 832-422-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 SAXON DR
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City | HOUSTON
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State | TX
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Zip | 77092-5543
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Country | US
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Telephone | 727-515-5792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN1001270
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15451
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 29859
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License Number State | TX
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