=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104278324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIREEN K IRANI DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2016
-----------------------------------------------------
Last Update Date | 07/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10710 ELDORADO PKWY 130
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-362-6820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10710 ELDORADO PKWY 130
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-362-6820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHIREEN IRANI
-----------------------------------------------------
Credential | DDS MS
-----------------------------------------------------
Telephone | 512-507-5682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 23298
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------