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General NPI Number Information
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NPI Number | 1740603414
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL SPA PLLC DBA HORIZON DENTAL
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 11101 BURNET RD SUITE A-135
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City | AUSTIN
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State | TX
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Zip | 78758
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Country | US
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Telephone | 512-837-0936
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Fax | 512-837-4157
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Provider Business Mailing Address
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Address Line | 11101 BURNET RD SUITE A-135
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City | AUSTIN
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State | TX
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Zip | 78758
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Country | US
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Telephone | 512-837-0936
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Fax | 512-837-4157
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. ZEYAD B MUGHRABI
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Credential | OWNER/DDS
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Telephone | 512-837-0936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 25667
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License Number State | TX
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