=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174631840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAJID SHAROLLI, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 04/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 BROOK AVE
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-5626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-322-5297
-----------------------------------------------------
Fax | 940-322-5298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 BROOK AVE
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-5626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-322-5297
-----------------------------------------------------
Fax | 940-322-5298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. MAJID SHAROLLI
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 940-585-7409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19810
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------