Provider Demographics
NPI:1962620492
Name:ESLAMI, NEGAR (DDS,FAGD)
Entity type:Individual
Prefix:
First Name:NEGAR
Middle Name:
Last Name:ESLAMI
Suffix:
Gender:F
Credentials:DDS,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W 6TH ST
Mailing Address - Street 2:SUITE #365
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4773
Mailing Address - Country:US
Mailing Address - Phone:512-482-9383
Mailing Address - Fax:512-320-0064
Practice Address - Street 1:1717 W 6TH ST
Practice Address - Street 2:SUITE #365
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4773
Practice Address - Country:US
Practice Address - Phone:512-482-9383
Practice Address - Fax:512-320-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice