Healthcare Provider Details

I. General information

NPI: 1164655098
Provider Name (Legal Business Name): PARADISE DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 HWY 121 SUITE 300
MELISSA TX
75454-0000
US

IV. Provider business mailing address

2028 HWY 121 SUITE 300
MELISSA TX
75454
US

V. Phone/Fax

Practice location:
  • Phone: 972-837-2929
  • Fax: 972-837-2920
Mailing address:
  • Phone: 972-837-2929
  • Fax: 972-837-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18709
License Number StateTX

VIII. Authorized Official

Name: DR. NADIA TAIYARI
Title or Position: OWNER
Credential: D.D.S.
Phone: 972-837-2929