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General NPI Number Information
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NPI Number | 1164785622
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Entity Type | Organization
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Legal Business Name | WELL DENTAL GROUP
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 2304 TIDWELL RD
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City | HOUSTON
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State | TX
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Zip | 77093-6731
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Country | US
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Telephone | 832-377-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 2304 TIDWELL RD
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City | HOUSTON
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State | TX
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Zip | 77093-6731
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Country | US
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Telephone | 832-377-3030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARHAD SHIRAZIAN
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Credential | D.D.S
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Telephone | 281-804-3838
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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 | 19674
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License Number State | TX
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