Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 30933 | TX |
NPI | 1053796706 |
---|---|
Provider Name | Pooria Fallah Abed |
First Address | Dallas, TX 75207-3432 |
Second Address | Dallas, TX 75226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2015 |
Last Update Date | 02/02/2021 |