MEDICARE: LITTLE ROAD DENTAL GROUP, PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1437312618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ROAD DENTAL GROUP, PA

Provider Business Mailing Address
First Line	:	4004 LITTLE RD
Second Line	:	SUITE 100
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4480
Country	:	US
Telephone Number	:	817-483-1692
Fax Number	:	817-483-1792

Provider Business Practice Location Address
First Line	:	4004 LITTLE RD
Second Line	:	SUITE 100
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4480
Country	:	US
Telephone Number	:	817-483-1692
Fax Number	:	817-483-1792

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAJID SEHAT
Credential	:	D.D.S.
Telephone Number	:	817-483-1692

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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