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General NPI Number Information
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NPI Number | 1447430319
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Entity Type | Organization
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Legal Business Name | HEDIEH POURNIK DDS PA
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 23741 HWY 59 STE #1
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City | PORTER
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State | TX
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Zip | 77365
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Country | US
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Telephone | 281-354-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 23741 HWY 59 STE #1
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City | PORTER
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State | TX
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Zip | 77365
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Country | US
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Telephone | 281-354-1197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEDIEH POURNIK
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Credential | DDS
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Telephone | 832-754-8572
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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 | 21019
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License Number State | TX
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