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General NPI Number Information
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NPI Number | 1912462136
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Entity Type | Organization
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Legal Business Name | DEEP SEA DENTAL PLLC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 603 SOUTH EXPRESSWAY 83 SUITE H2
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-380-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 307 E UNIVERSITY DR
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City | EDINBURG
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State | TX
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Zip | 78539-3549
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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 | MEMBER
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Name | SHAHROUZ AKHAVAN
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Credential |
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Telephone | 956-380-2482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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