=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275305831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CELINA PEDIATRIC DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2023
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 S PRESTON ROAD SUITE 400
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 945-600-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 COTTONWOOD TRL
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-470-5016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIAS CHAHINE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 945-600-7600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------