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General NPI Number Information
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NPI Number | 1164864708
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Entity Type | Organization
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Legal Business Name | COWBOYS DENTAL
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 1725 S IH 35
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City | CARROLLTON
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State | TX
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Zip | 75006-7417
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Country | US
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Telephone | 972-242-6020
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Fax | 972-242-6549
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Provider Business Mailing Address
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Address Line | 1725 S IH 35
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City | CARROLLTON
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State | TX
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Zip | 75006-7417
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Country | US
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Telephone | 972-242-6020
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Fax | 972-242-6549
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Authorized Official
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Title or Position | D.D.S.
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Name | DR. MAJID MIRBAHAEDDIN
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Credential |
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Telephone | 972-242-6020
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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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