=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093673436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S DENTISTRY OF PASADENA, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2907 STRAWBERRY RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77502-5214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-947-8222
-----------------------------------------------------
Fax | 713-947-2471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2907 STRAWBERRY RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77502-5214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-947-8222
-----------------------------------------------------
Fax | 713-947-2471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ALI FARAJI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-515-5792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------