=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295259786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D&A DENTAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6162 E MOCKINGBIRD LN STE 205
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-6930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-295-9270
-----------------------------------------------------
Fax | 214-660-5340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6162 E MOCKINGBIRD LN STE 205
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-6930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-295-9270
-----------------------------------------------------
Fax | 214-660-5340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DARYA TIMIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 214-925-9270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 28285
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------