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General NPI Number Information
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NPI Number | 1265954150
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Entity Type | Organization
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Legal Business Name | SUPREME DENTAL CARE PLLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 5100 W SUBLETT RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76001-4860
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Country | US
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Telephone | 817-483-0779
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 W SUBLETT RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76001-4860
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Country | US
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Telephone | 817-483-0779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OSAMA A DARWEESH
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Credential | DDS
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Telephone | 817-483-0779
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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 | 28768
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License Number State | TX
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