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General NPI Number Information
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NPI Number | 1861946212
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Entity Type | Organization
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Legal Business Name | SASAN BASTANI, DDS, PLLC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 1825 WICHITA ST
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City | HOUSTON
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State | TX
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Zip | 77004-5952
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Country | US
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Telephone | 832-654-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22456
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City | HOUSTON
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State | TX
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Zip | 77227-2456
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Country | US
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Telephone | 832-654-3100
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SASAN BASTANI
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Credential | DDS
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Telephone | 832-654-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29371
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License Number State | TX
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