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General NPI Number Information
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NPI Number | 1356838981
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Entity Type | Organization
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Legal Business Name | FIREWHEEL PEDIATRIC DENTAL SPECIALISTS PLLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 4880 N PRESIDENT GEORGE BUSH HWY STE 104
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City | GARLAND
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State | TX
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Zip | 75040
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Country | US
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Telephone | 972-364-7472
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Fax |
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Provider Business Mailing Address
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Address Line | 4880 N PRESIDENT GEORGE BUSH HWY STE 104
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City | GARLAND
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State | TX
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Zip | 75040-2742
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Country | US
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Telephone | 972-364-7472
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAHEEB JAOUNI
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Credential | DDS, MS
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Telephone | 469-702-0286
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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 | 30555
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License Number State | TX
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