Provider Demographics
NPI:1366130858
Name:HABIBI, RAHIM
Entity type:Individual
Prefix:
First Name:RAHIM
Middle Name:
Last Name:HABIBI
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 1:3122 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1648
Mailing Address - Country:US
Mailing Address - Phone:832-533-4075
Mailing Address - Fax:
Practice Address - Street 1:4220 CARTWRIGHT RD STE 101
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5307
Practice Address - Country:US
Practice Address - Phone:832-533-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3596126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126900000XDental ProvidersDental Laboratory TechnicianGroup - Single Specialty