MEDICARE: YASIR M KACHROO

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901021905	MI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	31826	TX

General Provider Information

NPI Number	:	1508312208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASIR M KACHROO

Provider Business Mailing Address
First Line	:	8109 PERSIMMON ST.
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 N GARLAND AVE STE C
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-9418
Country	:	US
Telephone Number	:	972-276-4888
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	03/17/2018

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Directions to “ YASIR M KACHROO ” Practice Location

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