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General NPI Number Information
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NPI Number | 1508427410
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Entity Type | Individual
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Provider Name | FARIDA BHANU NOORBASH DDS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2019
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Last Update Date | 06/23/2019
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Provider Practice Location Address
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Address Line | 614 W 29TH ST STE 106
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City | SAN ANGELO
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State | TX
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Zip | 76903-2981
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Country | US
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Telephone | 602-472-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 APPALOOSA TRL APT 117
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City | SAN ANGELO
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State | TX
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Zip | 76901-5279
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Country | US
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Telephone | 602-472-1318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35379
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License Number State | TX
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