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General NPI Number Information
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NPI Number | 1518548783
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Entity Type | Organization
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Legal Business Name | FUSION CHILDREN'S DENTISTRY PLLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 19200 PRESTON RD STE 120
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City | DALLAS
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State | TX
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Zip | 75252-2450
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Country | US
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Telephone | 972-666-4949
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Fax | 972-666-4944
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Provider Business Mailing Address
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Address Line | 19200 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75252-2450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NILOOFAR KHALESSEH
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Credential | DDS, MS
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Telephone | 310-666-6071
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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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