=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134455066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FATEMEH EBRAHIMI DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2009
-----------------------------------------------------
Last Update Date | 10/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7521 SW FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-779-2273
-----------------------------------------------------
Fax | 713-778-9802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7521 SW FREEWAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-779-2273
-----------------------------------------------------
Fax | 713-778-9802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FATEMEH EBRAHIMI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 832-382-5626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------