1447371315 NPI number — DR. IRELIA MARIA MACHADO DDS, MS

Table of content: DR. IRELIA MARIA MACHADO DDS, MS (NPI 1447371315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447371315 NPI number — DR. IRELIA MARIA MACHADO DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHADO
Provider First Name:
IRELIA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
F

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:
1447371315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1322 CHASE OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KELLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76248-8296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-656-4265
Provider Business Mailing Address Fax Number:
817-656-4265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 MEDALLION CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-368-4331
Provider Business Practice Location Address Fax Number:
214-368-4661
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  22303 , 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)





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