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General NPI Number Information
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NPI Number | 1346749165
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Entity Type | Organization
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Legal Business Name | LUCKY TEETH PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 11851 FM423 SUITE 500
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City | LITTLE ELM
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State | TX
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Zip | 75068
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Country | US
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Telephone | 972-798-8282
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Fax | 972-798-8060
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Provider Business Mailing Address
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Address Line | 11851 FM423 SUITE 500
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City | LITTLE ELM
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State | TX
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Zip | 75068
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Country | US
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Telephone | 972-798-8282
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Fax | 972-798-8060
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Authorized Official
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Title or Position | OWNER PEDIATRIC DENTIST
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Name | ZIAD MASOUD
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Credential | DDS
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Telephone | 857-333-9441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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