MEDICARE: MINALI CORPORATION

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	1223P0221X	Pediatric Dentistry	29859	TX

General Provider Information

NPI Number	:	1295250785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINALI CORPORATION

Provider Business Mailing Address
First Line	:	5210 SAXON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-5543
Country	:	US
Telephone Number	:	832-563-2478
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 FULTON ST STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3642
Country	:	US
Telephone Number	:	832-422-5792
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MINA TABATABAI
Credential	:	DDS
Telephone Number	:	832-563-2478

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	08/07/2017

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Directions to “MINALI CORPORATION ” Practice Location

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