Provider Demographics
NPI:1760218853
Name:MARAGHEHPOUR, BITA (DDS, MPH, DABOP)
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:MARAGHEHPOUR
Suffix:
Gender:F
Credentials:DDS, MPH, DABOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N KIMBALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5572
Mailing Address - Country:US
Mailing Address - Phone:623-980-2315
Mailing Address - Fax:
Practice Address - Street 1:1160 N KIMBALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5572
Practice Address - Country:US
Practice Address - Phone:623-980-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.61586366122300000X, 1223X2210X
TX411631223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist