Provider Demographics
NPI:1043648181
Name:MONA PEDIATRIC DENTIST, PLLC
Entity type:Organization
Organization Name:MONA PEDIATRIC DENTIST, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSHIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-994-7567
Mailing Address - Street 1:20920 KUYKENDAHL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3378
Mailing Address - Country:US
Mailing Address - Phone:832-617-1111
Mailing Address - Fax:
Practice Address - Street 1:20920 KUYKENDAHL RD
Practice Address - Street 2:SUITE E
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3378
Practice Address - Country:US
Practice Address - Phone:832-617-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty