Provider Demographics
NPI:1902200231
Name:DIAN, FARID (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:DIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 KINGSLEY DR STE 127
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4213
Mailing Address - Country:US
Mailing Address - Phone:281-835-4849
Mailing Address - Fax:281-835-4847
Practice Address - Street 1:2975 KINGSLEY DR STE 127
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4213
Practice Address - Country:US
Practice Address - Phone:281-835-4849
Practice Address - Fax:281-835-4847
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641411223G0001X
TX356481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice