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General NPI Number Information
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NPI Number | 1700117728
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Entity Type | Organization
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Legal Business Name | ADVANT DENTAL PA
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 1550 S CUSTER RD STE 100
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City | MCKINNEY
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State | TX
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Zip | 75070-6435
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Country | US
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Telephone | 972-346-2992
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Fax | 972-347-9960
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Provider Business Mailing Address
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Address Line | 5729 LEBANON RD STE 144 BOX 347
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City | FRISCO
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State | TX
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Zip | 75034-7259
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Country | US
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Telephone | 972-346-2992
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Fax | 972-347-9960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOJAN E SAFAVI
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Credential | DDS
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Telephone | 972-346-2992
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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 | 21289
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License Number State | TX
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