# DENTAL BOUTIQUE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407220429
- **Authorized official:** DR. FARNAZ NICKI TAJALLI D.D.S (PRESIDENT)
- **Authorized official phone:** (832) 289-2273

## Contact information

- **Practice address:** 9738 KATY FWY STE 400, HOUSTON, TX 77055-6214
- **Practice address phone:** (832) 289-2273
- **Mailing address:** 13630 BEAMER RD STE 112, HOUSTON, TX 77089-6037
- **Mailing address phone:** (832) 289-2273
- **Mailing address fax:** (281) 754-4352

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 18889 | TX | Yes |

## Other

- **Enumeration date:** 11/16/2015
- **Last updated:** 11/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1285643692 | NPI | TX |