Provider Demographics
NPI:1255842449
Name:VERBENA FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:VERBENA FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:NARJIS
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:SAFVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-778-3333
Mailing Address - Street 1:709 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER ACADEMY
Mailing Address - State:TX
Mailing Address - Zip Code:76554-2605
Mailing Address - Country:US
Mailing Address - Phone:254-982-4750
Mailing Address - Fax:
Practice Address - Street 1:709 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER ACADEMY
Practice Address - State:TX
Practice Address - Zip Code:76554-2605
Practice Address - Country:US
Practice Address - Phone:254-982-4750
Practice Address - Fax:254-982-4750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERBENA FAMILY DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23103261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental