Provider Demographics
NPI:1861761553
Name:PEGHA KARIMI DDS PC
Entity type:Organization
Organization Name:PEGHA KARIMI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEGHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-264-8536
Mailing Address - Street 1:6511 W LOOP 1604 N
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6511 W LOOP 1604 N
Practice Address - Street 2:SUITE #105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5438
Practice Address - Country:US
Practice Address - Phone:210-688-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty