MEDICARE: UPTOWN DENTISTRY, P.C.

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	261QD0000X	Dental Clinic/Center
2	122300000X	Dentist

General Provider Information

NPI Number	:	1720682289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	4900 WOODWAY DR STE 730
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1847
Country	:	US
Telephone Number	:	713-963-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 WOODWAY DR STE 730
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1847
Country	:	US
Telephone Number	:	713-963-9191
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FARNAZ NICKI TAJALLI
Credential	:	D.D.S.
Telephone Number	:	713-963-9191

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	07/10/2024

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