Provider Demographics
NPI:1508427410
Name:NOORBASH, FARIDA BHANU (DDS)
Entity Type:Individual
Prefix:
First Name:FARIDA
Middle Name:BHANU
Last Name:NOORBASH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 APPALOOSA TRL APT 117
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5279
Mailing Address - Country:US
Mailing Address - Phone:602-472-1318
Mailing Address - Fax:
Practice Address - Street 1:614 W 29TH ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-2981
Practice Address - Country:US
Practice Address - Phone:602-472-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice