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General NPI Number Information
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NPI Number | 1497253231
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Entity Type | Individual
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Provider Name | PEGAH MEMAR ARDESTANI DDS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 3902 N FRY RD STE C
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City | KATY
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State | TX
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Zip | 77449-6840
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Country | US
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Telephone | 281-945-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 WESTHEIMER RD APT 2114
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City | HOUSTON
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State | TX
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Zip | 77098-1788
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Country | US
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Telephone | 713-933-4036
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 33700
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License Number State | TX
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