Provider Demographics
NPI:1114372588
Name:ALLEN FAIZ DDS PA
Entity Type:Organization
Organization Name:ALLEN FAIZ DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEP/ CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-231-3188
Mailing Address - Street 1:1311 W CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2815
Mailing Address - Country:US
Mailing Address - Phone:972-231-3188
Mailing Address - Fax:972-231-3148
Practice Address - Street 1:1311 WEST CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-231-3188
Practice Address - Fax:972-231-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18506332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090713101Medicaid