Provider Demographics
NPI:1972163152
Name:LALEZARI, KIMIA (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMIA
Middle Name:
Last Name:LALEZARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E PARMER LN STE E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-7143
Mailing Address - Country:US
Mailing Address - Phone:737-717-3500
Mailing Address - Fax:
Practice Address - Street 1:1610 E PARMER LN STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-7143
Practice Address - Country:US
Practice Address - Phone:737-717-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24141122300000X, 1223G0001X
TX351991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist