Provider Demographics
NPI:1730429481
Name:FERDOUSIAN, JINOUS
Entity type:Individual
Prefix:
First Name:JINOUS
Middle Name:
Last Name:FERDOUSIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WINDHAVEN PKWY APT 3326
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6676
Mailing Address - Country:US
Mailing Address - Phone:703-401-4826
Mailing Address - Fax:
Practice Address - Street 1:143 S DENTON TAP RD STE 180
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3375
Practice Address - Country:US
Practice Address - Phone:703-401-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist