MEDICARE: SHARAREH PISHEH D.D.S

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	122300000X	Dentist	27145	TX

General Provider Information

NPI Number	:	1255628236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARAREH PISHEH D.D.S

Provider Business Mailing Address
First Line	:	6239 CHANNELBROOK LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3065
Country	:	US
Telephone Number	:	832-596-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 STEWART RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1841
Country	:	US
Telephone Number	:	409-741-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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