Provider Demographics
NPI:1386940674
Name:SCYENE DENTAL PLAZA PA
Entity type:Organization
Organization Name:SCYENE DENTAL PLAZA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-504-6317
Mailing Address - Street 1:10215 SCYENE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4931
Mailing Address - Country:US
Mailing Address - Phone:972-677-7832
Mailing Address - Fax:972-677-7915
Practice Address - Street 1:10215 SCYENE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4931
Practice Address - Country:US
Practice Address - Phone:972-677-7832
Practice Address - Fax:972-677-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty