Provider Demographics
NPI:1548482714
Name:HUMERA YAZDANI,D.D.S.,P.A.
Entity type:Organization
Organization Name:HUMERA YAZDANI,D.D.S.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMERA
Authorized Official - Middle Name:F
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-752-5200
Mailing Address - Street 1:2703 S HWY 6
Mailing Address - Street 2:STE 147
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-752-5200
Mailing Address - Fax:281-752-5211
Practice Address - Street 1:2703 S HWY 6
Practice Address - Street 2:STE 147
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-752-5200
Practice Address - Fax:281-752-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009516802Medicaid
TXB19512-1OtherCHIP