Provider Demographics
NPI:1194993287
Name:BEHZAD NAZARI
Entity type:Organization
Organization Name:BEHZAD NAZARI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-263-8900
Mailing Address - Street 1:6206 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-2615
Mailing Address - Country:US
Mailing Address - Phone:713-263-8900
Mailing Address - Fax:713-263-7479
Practice Address - Street 1:6206 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2615
Practice Address - Country:US
Practice Address - Phone:713-263-8900
Practice Address - Fax:713-263-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194701223G0001X
TX225131223G0001X
TX210191223G0001X
TX232941223G0001X
TX225921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090816201Medicaid