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General NPI Number Information
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NPI Number | 1598149981
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Entity Type | Organization
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Legal Business Name | EMPIRE DENTISTRY PLLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 5509 PLEASANT VALLEY DR 90A
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City | PLANO
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State | TX
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Zip | 75023-5248
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Country | US
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Telephone | 469-313-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 PLEASANT VALLEY DR 90A
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City | PLANO
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State | TX
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Zip | 75023-5248
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Country | US
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Telephone | 469-313-3057
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Fax |
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Authorized Official
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Title or Position | DDS/DENTIST
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Name | MUHIBUNNISA SHAIK
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Credential | DDS
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Telephone | 469-313-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28693
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License Number State | TX
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