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General NPI Number Information
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NPI Number | 1851635064
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Entity Type | Organization
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Legal Business Name | ISALAND DENTAL
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 6206 ANTOINE DR
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City | HOUSTON
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State | TX
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Zip | 77091-2615
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Country | US
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Telephone | 713-263-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 6206 ANTOINE DR
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City | HOUSTON
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State | TX
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Zip | 77091-2615
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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 | OWNER
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Name | DR. SHAHLA ZAKERZADEH
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Credential | DDS
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Telephone | 281-704-5684
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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 | 23424
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License Number State | TX
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