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General NPI Number Information
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NPI Number | 1508241019
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Entity Type | Individual
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Provider Name | SHAHNAM AMINI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2015
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Last Update Date | 07/25/2015
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Provider Practice Location Address
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Address Line | 3109 EDGAR BROWN DR
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City | WEST ORANGE
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State | TX
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Zip | 77630-5380
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Country | US
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Telephone | 409-330-4252
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Fax |
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Provider Business Mailing Address
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Address Line | 3214 BROOKGREEN DR
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City | KINGWOOD
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State | TX
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Zip | 77339-1963
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Country | US
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Telephone | 832-643-8429
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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 | 31211
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License Number State | TX
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