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General NPI Number Information
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NPI Number | 1093155020
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Entity Type | Organization
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Legal Business Name | FRESH SMILE, PC
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 3222 HILLCROFT ST
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City | HOUSTON
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State | TX
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Zip | 77057-5806
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Country | US
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Telephone | 281-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 HILLCROFT ST
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City | HOUSTON
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State | TX
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Zip | 77057-5806
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Country | US
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Telephone | 281-999-9999
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. FARNAZ DIANI
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Credential | D.D.S.
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Telephone | 713-517-5375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | TX
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