Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 30441 | TX |
NPI | 1043615511 |
---|---|
Provider Name | Ghazaleh Ghaneh |
First Address | Houston, TX 77030-4222 |
Second Address | Houston, TX 77054-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2014 |
Last Update Date | 27/10/2014 |