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General NPI Number Information
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NPI Number | 1720682289
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Entity Type | Organization
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Legal Business Name | UPTOWN DENTISTRY, P.C.
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 4900 WOODWAY DR STE 730
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City | HOUSTON
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State | TX
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Zip | 77056-1847
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Country | US
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Telephone | 713-963-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 WOODWAY DR STE 730
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City | HOUSTON
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State | TX
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Zip | 77056-1847
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Country | US
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Telephone | 713-963-9191
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FARNAZ NICKI TAJALLI
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Credential | D.D.S.
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Telephone | 713-963-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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