Provider Demographics
NPI:1972378297
Name:GHAZALEH PEIRAVANI DDS
Entity type:Organization
Organization Name:GHAZALEH PEIRAVANI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GHAZALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIRAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-702-3134
Mailing Address - Street 1:5304 DECKER DR,
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520
Mailing Address - Country:US
Mailing Address - Phone:949-702-3134
Mailing Address - Fax:281-428-7176
Practice Address - Street 1:5304 DECKER DR,
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520
Practice Address - Country:US
Practice Address - Phone:949-702-3134
Practice Address - Fax:281-428-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty