Provider Demographics
NPI:1063813061
Name:TALEBIQUJE, DAVOOD
Entity type:Individual
Prefix:
First Name:DAVOOD
Middle Name:
Last Name:TALEBIQUJE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 LINDA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2260 LINDA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2661
Practice Address - Country:US
Practice Address - Phone:432-333-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice