Provider Demographics
NPI:1780989665
Name:BASMA FALLAH DDS,MSD, PLLC
Entity type:Organization
Organization Name:BASMA FALLAH DDS,MSD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-248-4069
Mailing Address - Street 1:6252 DAVIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7422
Mailing Address - Country:US
Mailing Address - Phone:817-581-8881
Mailing Address - Fax:817-581-4337
Practice Address - Street 1:6252 DAVIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7422
Practice Address - Country:US
Practice Address - Phone:817-581-8881
Practice Address - Fax:817-581-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty