Provider Demographics
NPI:1962721878
Name:RADIANT ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:RADIANT ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-922-8838
Mailing Address - Street 1:9009 LONG POINT RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4665
Mailing Address - Country:US
Mailing Address - Phone:713-468-9009
Mailing Address - Fax:713-463-6403
Practice Address - Street 1:9009 LONG POINT RD
Practice Address - Street 2:SUITE A1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4665
Practice Address - Country:US
Practice Address - Phone:713-468-9009
Practice Address - Fax:713-463-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22757122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty