=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588967459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESHAT YAZDI DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2010
-----------------------------------------------------
Last Update Date | 12/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 N SHEPHERD DR STE D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-6500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-864-3993
-----------------------------------------------------
Fax | 713-426-2498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 N SHEPHERD DR STE D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-6500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-864-3993
-----------------------------------------------------
Fax | 713-426-2498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ TREATING PROVIDER
-----------------------------------------------------
Name | MRS. NESHAT YAZDI
-----------------------------------------------------
Credential | DDA PA
-----------------------------------------------------
Telephone | 713-864-3993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 20052
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------