Organization
CORAL DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHROUZ AKHAVAN DDS (OWNER)
(956) 380-2482
Entity
Organization
Contact information
Practice address
1503 N TEXAS BLVD, WESLACO, TX 78599-4213
(956) 380-2482
Mailing address
307 E UNIVERSITY DR, EDINBURG, TX 78539-3549
(956) 380-2482
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34127429
DRIVER LICENSE
TX
Enumeration date
09/01/2020
Last updated
09/01/2020
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