Provider Demographics
NPI:1851511240
Name:BAHARLOO AND FARZAM DDS PA
Entity Type:Organization
Organization Name:BAHARLOO AND FARZAM DDS PA
Other - Org Name:BAHARLOO AND FARZAM DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHARLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-695-8188
Mailing Address - Street 1:5516 AIRLINE DR
Mailing Address - Street 2:5516 AIRLINE DR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4904
Mailing Address - Country:US
Mailing Address - Phone:713-695-8188
Mailing Address - Fax:713-695-8191
Practice Address - Street 1:5516 AIRLINE DR
Practice Address - Street 2:5516 AIRLINE DR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4904
Practice Address - Country:US
Practice Address - Phone:713-695-8188
Practice Address - Fax:713-695-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190271223G0001X
TX186881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty