Provider Demographics
NPI:1851033773
Name:FREEPORT COMPREHENSIVE DENTISTRY PLLC
Entity Type:Organization
Organization Name:FREEPORT COMPREHENSIVE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIDNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-233-6000
Mailing Address - Street 1:313 S BRAZOSPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-4506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 S BRAZOSPORT BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-4506
Practice Address - Country:US
Practice Address - Phone:979-233-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty