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General NPI Number Information
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NPI Number | 1619123536
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Entity Type | Organization
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Legal Business Name | AESTHETIC DENTISTRY, PA
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 4500 HILLCREST RD SUITE 190
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City | FRISCO
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State | TX
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Zip | 75035-5418
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Country | US
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Telephone | 972-335-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 HILLCREST RD SUITE 190
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City | FRISCO
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State | TX
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Zip | 75035-5418
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Country | US
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Telephone | 972-335-7100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AFSHIN VAHADI
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Credential |
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Telephone | 972-335-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17001
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License Number State | TX
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