Provider Demographics
NPI:1588967459
Name:NESHAT YAZDI DDS PA
Entity type:Organization
Organization Name:NESHAT YAZDI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ TREATING PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NESHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDA PA
Authorized Official - Phone:713-864-3993
Mailing Address - Street 1:915 N SHEPHERD DR STE D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6500
Mailing Address - Country:US
Mailing Address - Phone:713-864-3993
Mailing Address - Fax:713-426-2498
Practice Address - Street 1:915 N SHEPHERD DR STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6500
Practice Address - Country:US
Practice Address - Phone:713-864-3993
Practice Address - Fax:713-426-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007886702Medicaid
TX007886703Medicaid