Healthcare Provider Details

I. General information

NPI: 1871744136
Provider Name (Legal Business Name): BEHNAM ESLAMI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N 11TH ST
GARLAND TX
75040-6103
US

IV. Provider business mailing address

116 N 11TH ST
GARLAND TX
75040-6103
US

V. Phone/Fax

Practice location:
  • Phone: 972-276-0159
  • Fax:
Mailing address:
  • Phone: 972-276-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24988
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number24988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: