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General NPI Number Information
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NPI Number | 1184933400
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Entity Type | Organization
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Legal Business Name | GRAND DENTAL PA
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 5437 E GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75223-1914
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Country | US
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Telephone | 214-821-4726
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Fax |
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Provider Business Mailing Address
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Address Line | 850 DALMALLEY LN
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City | COPPELL
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State | TX
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Zip | 75019-7931
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Country | US
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Telephone | 214-821-4726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAED AJLOUNI
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Credential | DDS
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Telephone | 214-995-0806
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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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