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General NPI Number Information
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NPI Number | 1750873782
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Entity Type | Organization
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Legal Business Name | MINEOLA DENTAL PLLC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 344 NW LOOP 564 STE 400
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City | MINEOLA
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State | TX
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Zip | 75773-1128
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Country | US
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Telephone | 903-948-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 CEDAR BRUSH DR
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City | FORT WORTH
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State | TX
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Zip | 76123-2962
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Country | US
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Telephone | 423-946-9375
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROHIT NARAYAN
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Credential | DDS
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Telephone | 423-946-9375
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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 | 26309
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License Number State | TX
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