Provider Demographics
NPI:1679763213
Name:DACCAK, RAZAN (DDS)
Entity type:Individual
Prefix:MS
First Name:RAZAN
Middle Name:
Last Name:DACCAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE H
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3950
Mailing Address - Country:US
Mailing Address - Phone:832-426-4433
Mailing Address - Fax:713-492-2231
Practice Address - Street 1:4450 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE H
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:832-426-4433
Practice Address - Fax:713-492-2231
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226641223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist