Provider Demographics
NPI:1790674661
Name:DANYAL KHOSRAVI, MOJGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:DANYAL KHOSRAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 EAGLE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4216
Mailing Address - Country:US
Mailing Address - Phone:920-815-9022
Mailing Address - Fax:
Practice Address - Street 1:6601 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3687
Practice Address - Country:US
Practice Address - Phone:832-930-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice