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General NPI Number Information
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NPI Number | 1649744293
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Entity Type | Organization
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Legal Business Name | PRIME ORAL WELLNESS &DENTISTRY PLLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 3821 LONG PRAIRIE RD STE 200
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1599
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Country | US
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Telephone | 972-885-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 LONG PRAIRIE RD STE 200
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1599
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Country | US
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Telephone | 972-885-9191
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MINAXI MIRKAL
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Credential | DDS
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Telephone | 972-885-9191
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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 |
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License Number State |
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