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General NPI Number Information
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NPI Number | 1750604609
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Entity Type | Organization
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Legal Business Name | MAPLE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 03/07/2010
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Last Update Date | 03/07/2010
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Provider Practice Location Address
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Address Line | 4611 COLUMBIA AVE SUITE 104
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City | DALLAS
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State | TX
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Zip | 75226-2306
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Country | US
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Telephone | 214-517-9608
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Fax | 214-827-8001
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Provider Business Mailing Address
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Address Line | 4611 COLUMBIA AVE SUITE 104
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City | DALLAS
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State | TX
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Zip | 75226-2306
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Country | US
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Telephone | 214-517-9608
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Fax | 214-827-8001
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Authorized Official
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Title or Position | DDS, OWNER
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Name | DR. MITA DESAI
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Credential | DDS
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Telephone | 214-517-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21968
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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