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General NPI Number Information
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NPI Number | 1396491320
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Entity Type | Individual
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Provider Name | COURTNEY MICHEL FAVALORO DDS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 9757 WHITE ROCK TRL
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City | DALLAS
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State | TX
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Zip | 75238-1805
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Country | US
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Telephone | 214-349-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 5841 ORAM ST UNIT 3
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City | DALLAS
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State | TX
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Zip | 75206-7229
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Country | US
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Telephone | 713-829-2337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 40999
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License Number State | TX
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