MEDICARE: MELANIE LEBLANC FARZAM, D.D.S., P.L.L.C.

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	122300000X	Dentist	24740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801171921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANIE LEBLANC FARZAM, D.D.S., P.L.L.C.

Provider Business Mailing Address
First Line	:	2615 SOUTHWEST FWY
Second Line	:	SUITE 190
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-871-8800
Fax Number	:	713-871-8881

Provider Business Practice Location Address
First Line	:	2615 SOUTHWEST FWY
Second Line	:	SUITE 190
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-871-8800
Fax Number	:	713-871-8881

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MELANIE LEBLANC FARZAM
Credential	:	DDS
Telephone Number	:	713-871-8800

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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