1043724453 NPI number — PALMHURST DENTAL AND ORTHODONTICS PLLC

Table of content: ASHLEY FELLERS MCKENZIE MD (NPI 1831891324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043724453 NPI number — PALMHURST DENTAL AND ORTHODONTICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMHURST DENTAL AND ORTHODONTICS 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:
1043724453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 E MILE 3 RD UNIT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMHURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78573-0156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 E MILE 3 RD UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMHURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78573-0156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-529-8151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ZARRABI
Authorized Official First Name:
SAAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-529-8151

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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