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General NPI Number Information
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NPI Number | 1679306351
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Entity Type | Organization
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Legal Business Name | TEXAS DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 5240 FM 2920 RD # 400
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City | SPRING
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State | TX
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Zip | 77388-3003
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Country | US
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Telephone | 903-245-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 5240 FM 2920 RD # 400
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City | SPRING
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State | TX
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Zip | 77388-3003
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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 | MANAGER
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Name | SHERVIN AMINI
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Credential |
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Telephone | 713-465-8239
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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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