Provider Demographics
NPI:1548320518
Name:RAHGOZAR, MAHIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHIN
Middle Name:
Last Name:RAHGOZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FONDREN RD.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:713-974-7252
Mailing Address - Fax:713-974-5822
Practice Address - Street 1:2500 FONDREN RD.
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063
Practice Address - Country:US
Practice Address - Phone:713-974-7252
Practice Address - Fax:713-974-5822
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009577007Medicaid