Provider Demographics
NPI:1699758789
Name:ANVAR, HOOSHANG (DDS)
Entity type:Individual
Prefix:DR
First Name:HOOSHANG
Middle Name:
Last Name:ANVAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13519 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5305
Mailing Address - Country:US
Mailing Address - Phone:718-445-7030
Mailing Address - Fax:718-353-0593
Practice Address - Street 1:13519 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5305
Practice Address - Country:US
Practice Address - Phone:718-445-7030
Practice Address - Fax:718-353-0593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice