Provider Demographics
NPI:1578197208
Name:DENTAL LAND PLLC
Entity type:Organization
Organization Name:DENTAL LAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIROUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-434-6170
Mailing Address - Street 1:2525 SOUTHMORE AVE # SITE200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1451
Mailing Address - Country:US
Mailing Address - Phone:713-434-6170
Mailing Address - Fax:713-434-6189
Practice Address - Street 1:2525 SOUTHMORE AVE # SITE200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1451
Practice Address - Country:US
Practice Address - Phone:713-434-6170
Practice Address - Fax:713-434-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty