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General NPI Number Information
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NPI Number | 1861852584
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Entity Type | Organization
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Legal Business Name | BABAK GORAVANCHI DDS PA
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 1013 DAIRY ASHFORD RD
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City | HOUSTON
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State | TX
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Zip | 77079-4602
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Country | US
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Telephone | 713-446-8547
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 DAIRY ASHFORD RD
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City | HOUSTON
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State | TX
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Zip | 77079-4602
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Country | US
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Telephone | 713-446-8547
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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. BABAK GORAVANCHI
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Credential | DDS
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Telephone | 713-446-8547
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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 | 21389
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License Number State | TX
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