MEDICARE: MARJANEH A. AZAD, DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1285975367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARJANEH A. AZAD, DDS PA

Provider Business Mailing Address
First Line	:	6510 HILLCROFT ST STE 303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	713-722-6435
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT ST STE 303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	713-722-6435
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARJANEH AZAD
Credential	:	DDS
Telephone Number	:	713-722-6435

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	03/14/2013

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