Provider Demographics
NPI:1093471500
Name:NICHE DENTAL PPLC
Entity Type:Organization
Organization Name:NICHE DENTAL PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:BHANU
Authorized Official - Last Name:NOORBASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MBA
Authorized Official - Phone:602-472-1318
Mailing Address - Street 1:3203 GOLDEN HONEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2690
Mailing Address - Country:US
Mailing Address - Phone:602-472-1318
Mailing Address - Fax:
Practice Address - Street 1:4031 FM 1463 RD STE 99
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5964
Practice Address - Country:US
Practice Address - Phone:602-472-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service