Provider Demographics
NPI:1043350374
Name:AHANGARADEH, MANSOUR (DDS)
Entity type:Individual
Prefix:
First Name:MANSOUR
Middle Name:
Last Name:AHANGARADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2542
Mailing Address - Country:US
Mailing Address - Phone:817-275-2229
Mailing Address - Fax:817-277-5522
Practice Address - Street 1:803 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2542
Practice Address - Country:US
Practice Address - Phone:817-275-2229
Practice Address - Fax:817-277-5522
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice