1437648110 NPI number — DENTISTS OF MIDLOTHIAN AND ORTHODONTICS PC

Table of content: (NPI 1437648110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437648110 NPI number — DENTISTS OF MIDLOTHIAN AND ORTHODONTICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTISTS OF MIDLOTHIAN AND ORTHODONTICS PC
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:
6
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:
1437648110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75392-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-845-8500
Provider Business Mailing Address Fax Number:
303-952-0892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 FM 663 STE 420
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76065-6509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-528-4802
Provider Business Practice Location Address Fax Number:
972-528-4802
Provider Enumeration Date:
05/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ABDELJALIL
Authorized Official First Name:
REMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-528-4802

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)





Copyright © 2007-2025 www.npivalidator.com