Provider Demographics
NPI:1144287111
Name:PAHLAVAN, POORANG (DDS)
Entity type:Individual
Prefix:
First Name:POORANG
Middle Name:
Last Name:PAHLAVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3737
Mailing Address - Country:US
Mailing Address - Phone:281-447-7220
Mailing Address - Fax:281-447-7221
Practice Address - Street 1:410 W LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1305
Practice Address - Country:US
Practice Address - Phone:281-447-7220
Practice Address - Fax:281-447-7221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice