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General NPI Number Information
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NPI Number | 1245047703
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Entity Type | Organization
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Legal Business Name | DAZZLE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 245 E GRAUWYLER RD STE 109
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City | IRVING
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State | TX
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Zip | 75061-2635
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Country | US
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Telephone | 214-596-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 8397 HAMILTON LN
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City | FRISCO
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State | TX
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Zip | 75036-7843
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KHALED SHALABY
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Credential |
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Telephone | 332-237-8104
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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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