Individual
MINA TABATABAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7700 FULTON ST STE A, HOUSTON, TX 77022-3642
(832) 422-5792
Mailing address
5210 SAXON DR, HOUSTON, TX 77092-5543
(727) 515-5792
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
15451
MD
1223G0001X
General Practice Dentistry
DEN1001270
DC
1223P0221X
Pediatric Dentistry
Primary
29859
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
353682310
—
TX
Enumeration date
07/19/2013
Last updated
05/10/2018
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