Provider Demographics
NPI:1811161227
Name:VERBENA FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:VERBENA FAMILY DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARJIS
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:SAFVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:254-778-3333
Mailing Address - Street 1:179 VERBENA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-778-3333
Mailing Address - Fax:254-778-3337
Practice Address - Street 1:179 VERBENA DRIVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:254-778-3333
Practice Address - Fax:254-778-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23103261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental