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General NPI Number Information
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NPI Number | 1508260894
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Entity Type | Organization
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Legal Business Name | FATEMEH EBRAHIMI DDS PLLC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 6430 RICHMOND AVE STE 110
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City | HOUSTON
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State | TX
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Zip | 77057-5908
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Country | US
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Telephone | 713-779-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 7521 SOUTHWEST FWY
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City | HOUSTON
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State | TX
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Zip | 77074-1903
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Country | US
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Telephone | 713-779-2273
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. FADI TATARI
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Credential | DDS
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Telephone | 832-444-9055
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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 | 19864
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License Number State | TX
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