MEDICARE: DR. FARNAM H FARZAM M.S., D.D.S.,P.A.

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	18688	TX

General Provider Information

NPI Number	:	1619972080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARNAM H FARZAM M.S., D.D.S.,P.A.

Provider Business Mailing Address
First Line	:	2615 SOUTHWEST FWY
Second Line	:	STE 190
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-871-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 SOUTHWEST FWY
Second Line	:	STE 190
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-871-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/28/2013

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