MEDICARE: DR. POONEH NAJAFI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20085	TX

General Provider Information

NPI Number	:	1346220795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POONEH NAJAFI DDS

Provider Business Mailing Address
First Line	:	3980 BOAT CLUB RD
Second Line	:	STE. 114
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3208
Country	:	US
Telephone Number	:	817-237-1600
Fax Number	:	817-237-2604

Provider Business Practice Location Address
First Line	:	3980 BOAT CLUB RD
Second Line	:	STE. 114
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3208
Country	:	US
Telephone Number	:	817-237-1600
Fax Number	:	817-237-2604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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