Provider Demographics
NPI:1447550215
Name:EBRAHIMI DENTAL MANAGEMENT LLC
Entity type:Organization
Organization Name:EBRAHIMI DENTAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:TATARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-217-7492
Mailing Address - Street 1:1901 POST OAK BLVD
Mailing Address - Street 2:4210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3868
Mailing Address - Country:US
Mailing Address - Phone:281-217-7492
Mailing Address - Fax:281-888-2299
Practice Address - Street 1:8240 ANTOINE DR
Practice Address - Street 2:206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2534
Practice Address - Country:US
Practice Address - Phone:281-217-7492
Practice Address - Fax:281-888-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty