Organization
ALTUS DENTAL SURGERY BEAUMONT, PA
Active
Other names
Altus Dental Surgery Center Beaumont
Organization subpart
No
Provider details
NPI number
Authorized official
POORANG PAHLAVAN DDS (OWNER)
(281) 427-5100
Entity
Organization
Contact information
Practice address
390 N 11TH ST, BEAUMONT, TX 77702-1802
(281) 427-5100
Mailing address
4508 GARTH RD, SUITE A, BAYTOWN, TX 77521-2154
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135073817
—
TX
05
—
1880833
—
TX
Enumeration date
08/14/2014
Last updated
08/14/2014
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