Provider Demographics
NPI:1225505704
Name:MEMON, FARAZ NABI (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARAZ NABI
Middle Name:
Last Name:MEMON
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 1:5418 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-9611
Mailing Address - Country:US
Mailing Address - Phone:617-763-4484
Mailing Address - Fax:
Practice Address - Street 1:12851 NARCOOSSEE RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7156
Practice Address - Country:US
Practice Address - Phone:407-749-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS615131223G0001X
FLDN281401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice