Basic Information
Provider Information
NPI: 1336451467
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOUZI
FirstName: SARA
MiddleName: SELINA
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1002B COLUMBUS ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 770194346
CountryCode: US
TelephoneNumber: 8327151595
FaxNumber:  
Practice Location
Address1: 5800 BELLAIRE BLVD STE 110
Address2:  
City: HOUSTON
State: TX
PostalCode: 770815537
CountryCode: US
TelephoneNumber: 7136674077
FaxNumber: 7133498027
Other Information
ProviderEnumerationDate: 07/06/2010
LastUpdateDate: 07/11/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X25563TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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