MEDICARE: AKHAVAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184397499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKHAVAN PLLC

Provider Business Mailing Address
First Line	:	1210 COTTONWOOD CREEK TRL STE 100
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2688
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 COTTONWOOD CREEK TRL STE 100
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2688
Country	:	US
Telephone Number	:	512-686-2100
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MOHAMMADREZA AKHAVAN SHARIF
Credential	:	DMD
Telephone Number	:	512-686-2100

Provider Enumeration Date	:	08/01/2021
Last Update Date	:	08/01/2021

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