Healthcare Provider Details

I. General information

NPI: 1831536838
Provider Name (Legal Business Name): AMEENA A TEKBALI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MATLOCK CENTRE CIR
ARLINGTON TX
76015-2535
US

IV. Provider business mailing address

4440 FRUITVILLE RD
SARASOTA FL
34232-1926
US

V. Phone/Fax

Practice location:
  • Phone: 817-693-1000
  • Fax: 904-293-4222
Mailing address:
  • Phone: 941-300-4440
  • Fax: 941-404-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: