Healthcare Provider Details

I. General information

NPI: 1255720132
Provider Name (Legal Business Name): AESTHETIC LDP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 MIDWAY RD
PLANO TX
75093-1611
US

IV. Provider business mailing address

2304 MIDWAY RD
PLANO TX
75093-1611
US

V. Phone/Fax

Practice location:
  • Phone: 972-473-8880
  • Fax: 972-473-8882
Mailing address:
  • Phone: 972-473-8880
  • Fax: 972-473-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN MUAINA
Title or Position: OWNER
Credential:
Phone: 513-633-4219