MEDICARE: DR. RADWAN MONZER TASSABHJI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		TX

General Provider Information

NPI Number	:	1144152067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADWAN MONZER TASSABHJI DMD

Provider Business Mailing Address
First Line	:	4428 RED BARN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-2680
Country	:	US
Telephone Number	:	214-616-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 E LAMAR BLVD STE 106
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7403
Country	:	US
Telephone Number	:	817-274-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/05/2026

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