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General NPI Number Information
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NPI Number | 1609663830
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Entity Type | Organization
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Legal Business Name | MEMORIAL DENTAL & ORTHODONTICS PLLC
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 1385 MEMORIAL PKWY STE 5
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City | FATE
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State | TX
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Zip | 75189
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Country | US
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Telephone | 972-382-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 1385 MEMORIAL PKWY STE 5
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City | FATE
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State | TX
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Zip | 75189
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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 | CREDENTIALING TEAM LEAD
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Name | PAOLA RAMOS
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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