Provider Demographics
NPI:1801171921
Name:MELANIE LEBLANC FARZAM, D.D.S., P.L.L.C.
Entity type:Organization
Organization Name:MELANIE LEBLANC FARZAM, D.D.S., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LEBLANC
Authorized Official - Last Name:FARZAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-871-8800
Mailing Address - Street 1:2615 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4609
Mailing Address - Country:US
Mailing Address - Phone:713-871-8800
Mailing Address - Fax:713-871-8881
Practice Address - Street 1:2615 SOUTHWEST FWY
Practice Address - Street 2:SUITE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4609
Practice Address - Country:US
Practice Address - Phone:713-871-8800
Practice Address - Fax:713-871-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205040303Medicaid