Active NPI
Pooria Fallah Abed, DDS
- Periodontics
- Dallas, TX
National Provider Identifier
1053796706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 30933
- Practice address
- 3000 Gaston Ave
Dallas, TX 75226 - Phone
- (310) 962-6151
- NPI assigned
- Jul 23, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30933 | TX | Primary |
Addresses
Primary practice location
3000 Gaston Ave
Dallas, TX 75226
Mailing address
1400 Hi Line Dr Apt 1509
Dallas, TX 75207-3432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171013001383 | TX | Order and Referring Only - Dentist | 3870868003 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30933 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612224000000",
"number": "1053796706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 HI LINE DR APT 1509",
"city": "DALLAS",
"state": "TX",
"postal_code": "752073432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 GASTON AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75226",
"telephone_number": "310-962-6151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALLAH ABED",
"first_name": "POORIA",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-23",
"last_updated": "2021-02-02",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "30933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.