Healthcare Provider Details

I. General information

NPI: 1043793243
Provider Name (Legal Business Name): DDSPERIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N BELT LINE RD STE 101
MESQUITE TX
75149-1784
US

IV. Provider business mailing address

1313 N BELT LINE RD STE 101
MESQUITE TX
75149-1784
US

V. Phone/Fax

Practice location:
  • Phone: 972-289-3330
  • Fax: 972-289-3633
Mailing address:
  • Phone: 972-289-3330
  • Fax: 972-289-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RASHID BEIRUTE-PRADA
Title or Position: OWNER
Credential: DDS
Phone: 972-289-3330