Provider Demographics
NPI:1659911196
Name:FFARZAMLLC
Entity Type:Organization
Organization Name:FFARZAMLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARNAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARZAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-610-0428
Mailing Address - Street 1:12430 GRANT ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:832-418-6816
Mailing Address - Fax:
Practice Address - Street 1:12430 GRANT ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:832-418-6816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty