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General NPI Number Information
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NPI Number | 1740844760
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Entity Type | Organization
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Legal Business Name | NOVASMILE DENTAL PLLC
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 2131 N COLLINS ST STE 415
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City | ARLINGTON
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State | TX
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Zip | 76011-2811
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Country | US
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Telephone | 817-801-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 6772 PLAZA VIA
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City | IRVING
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State | TX
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Zip | 75039-3127
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Country | US
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Telephone | 818-876-2947
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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. NIOSHA EDALAT
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Credential | DDS
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Telephone | 818-876-2947
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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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