=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386000610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLOUD DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2015
-----------------------------------------------------
Last Update Date | 01/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9070 RESEARCH BLVD # 205A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-7004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-351-4080
-----------------------------------------------------
Fax | 512-351-4084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 ARPDALE ST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-351-4080
-----------------------------------------------------
Fax | 512-351-4084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOOMAN Z SAMANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-351-4080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 28016
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------