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General NPI Number Information
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NPI Number | 1174086284
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Entity Type | Organization
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Legal Business Name | GROWING SMILES OF ANNA PLLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 2530 W WHITE ST SUITE 104
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City | ANNA
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State | TX
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Zip | 75409-7508
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Country | US
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Telephone | 214-501-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 SHIRE BLVD STE 110
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City | RICHARDSON
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State | TX
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Zip | 75082-2239
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Country | US
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Telephone | 214-501-2721
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD RAGHID ALOLABI
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Credential | DDS
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Telephone | 214-501-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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