Provider Demographics
NPI:1205377355
Name:ZONOOZI, FARHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:ZONOOZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 DACOMA STREET STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:346-398-5390
Mailing Address - Fax:346-398-5391
Practice Address - Street 1:4530 DACOMA STREET STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092
Practice Address - Country:US
Practice Address - Phone:346-398-5390
Practice Address - Fax:346-398-5391
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041332122300000X, 1223G0001X
TX37580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice