1114222627 NPI number — OUR DENTIST PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114222627 NPI number — OUR DENTIST PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR DENTIST PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114222627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2736 VALLEY VIEW LN
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-4925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-241-1352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8025 AMBIANCE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-6839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-688-3171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NESARIKAR
Authorized Official First Name:
SHALAKA
Authorized Official Middle Name:
ABHIJIT
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
972-241-1352

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  21144 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)