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General NPI Number Information
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NPI Number | 1033975172
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Entity Type | Organization
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Legal Business Name | IDEAL DENTAL BURLESON PLLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 265 NW JOHN JONES DR STE 105
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City | BURLESON
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State | TX
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Zip | 76028-5871
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Country | US
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Telephone | 817-566-1244
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Fax | 682-257-3597
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Provider Business Mailing Address
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Address Line | PO BOX 840925
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City | DALLAS
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State | TX
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Zip | 75284-0925
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Country | US
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Telephone | 972-331-8067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHALIN PATEL
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Credential | DMD
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Telephone | 972-331-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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