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General NPI Number Information
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NPI Number | 1295250785
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Entity Type | Organization
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Legal Business Name | MINALI CORPORATION
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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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 | 832-563-2478
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MINA TABATABAI
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Credential | DDS
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Telephone | 832-563-2478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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