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General NPI Number Information
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NPI Number | 1659610020
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Entity Type | Organization
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Legal Business Name | ALTUS DENTAL P.A.
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 4508 GARTH RD SUITE#A
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City | BAYTOWN
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State | TX
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Zip | 77521-2154
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Country | US
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Telephone | 281-427-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 11233 SHADOW CREEK PKWY SUITE #313
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City | PEARLAND
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State | TX
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Zip | 77584-7345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SOROUSH ESFANDIARI
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Credential | D.D.S
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Telephone | 713-667-9311
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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 | 20196
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License Number State | TX
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