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General NPI Number Information
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NPI Number | 1114312154
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PRO CHILDREN'S DENTISTRY & ORTHODONTICS
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 1234 NORTHWEST HWY
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City | GARLAND
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State | TX
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Zip | 75041-5834
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Country | US
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Telephone | 978-729-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 NORTHWEST HWY
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City | GARLAND
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State | TX
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Zip | 75041-5834
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Country | US
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Telephone | 214-380-5054
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Fax |
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Authorized Official
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Title or Position | OWNER PEDIATRIC DENTIST
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Name | DR. ALI BAYAT
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Credential | DMD
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Telephone | 214-380-5054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 27545
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License Number State | TX
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