Provider Demographics
NPI:1134130891
Name:SOUTH BELT DENTAL, P.A.
Entity Type:Organization
Organization Name:SOUTH BELT DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:NICKI
Authorized Official - Last Name:TAJALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-540-2250
Mailing Address - Street 1:13630 BEAMER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6069
Mailing Address - Country:US
Mailing Address - Phone:281-481-2273
Mailing Address - Fax:
Practice Address - Street 1:13630 BEAMER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6069
Practice Address - Country:US
Practice Address - Phone:281-481-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty