Healthcare Provider Details

I. General information

NPI: 1245287424
Provider Name (Legal Business Name): FATEMEH Z SAMANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 LIME CREEK RD
VOLENTE TX
78641-9105
US

IV. Provider business mailing address

3407 WELLS BRANCH PKWY SUITE #700
AUSTIN TX
78728-6632
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-7677
  • Fax: 512-244-9672
Mailing address:
  • Phone: 512-244-7677
  • Fax: 512-244-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16598
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: