Healthcare Provider Details

I. General information

NPI: 1457419483
Provider Name (Legal Business Name): NADIA TAIYARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 HWY 121, 300
MELISSA TX
75454-2391
US

IV. Provider business mailing address

2028 HWY 121 SUITE 300
MELISSA TX
75454-2391
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18709
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: