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General NPI Number Information
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NPI Number | 1861761553
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Entity Type | Organization
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Legal Business Name | PEGHA KARIMI DDS PC
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Dates
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Enumeration Date | 12/24/2011
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Last Update Date | 12/24/2011
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Provider Practice Location Address
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Address Line | 6511 W LOOP 1604 N SUITE #105
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City | SAN ANTONIO
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State | TX
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Zip | 78254-5438
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Country | US
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Telephone | 210-688-2204
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Fax |
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Provider Business Mailing Address
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Address Line | 6511 W LOOP 1604 N SUITE #105
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City | SAN ANTONIO
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State | TX
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Zip | 78254-5438
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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 | PRESIDENT
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Name | PEGHA KARIMI
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Credential | DDS
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Telephone | 210-264-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 23632
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License Number State | TX
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