Individual
IDA ETTEHADIEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4310 MOUNTAIN FLOWER CT, HOUSTON, TX 77059-5528
(281) 705-5667
Mailing address
4310 MOUNTAIN FLOWER CT, HOUSTON, TX 77059-5528
(281) 705-5667
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
35400
TX
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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