MEDICARE: ORACLE INDUSTRIES

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	122300000X	Dentist

General Provider Information

NPI Number	:	1811551690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORACLE INDUSTRIES

Provider Business Mailing Address
First Line	:	8325 WALNUT HILL LN STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4212
Country	:	US
Telephone Number	:	214-696-3082
Fax Number	:	214-696-4607

Provider Business Practice Location Address
First Line	:	8325 WALNUT HILL LN STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4212
Country	:	US
Telephone Number	:	214-696-3082
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	SHAWNA RIDDELL
Credential	:
Telephone Number	:	214-696-3082

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	04/26/2019

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Directions to “ORACLE INDUSTRIES ” Practice Location

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