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General NPI Number Information
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NPI Number | 1174139190
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Entity Type | Organization
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Legal Business Name | LAUREL DENTAL TX PLLC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 10824 E CRYSTAL FALLS PKWY # 303
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City | LEANDER
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State | TX
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Zip | 78641-4300
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Country | US
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Telephone | 801-598-9676
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Fax |
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Provider Business Mailing Address
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Address Line | 10824 E CRYSTAL FALLS PKWY # 303
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City | LEANDER
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State | TX
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Zip | 78641-4300
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Country | US
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Telephone | 512-900-1720
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ALIISHA CHOUCAIR
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Credential | DMD
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Telephone | 512-900-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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