Organization
DENTAL BOUTIQUE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARNAZ NICKI TAJALLI D.D.S (PRESIDENT)
(832) 289-2273
Entity
Organization
Contact information
Practice address
9738 KATY FWY STE 400, HOUSTON, TX 77055-6214
(832) 289-2273
Mailing address
13630 BEAMER RD STE 112, HOUSTON, TX 77089-6037
(832) 289-2273
(281) 754-4352
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18889
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285643692
NPI
TX
Enumeration date
11/16/2015
Last updated
11/16/2015
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