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General NPI Number Information
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NPI Number | 1780186205
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Entity Type | Organization
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Legal Business Name | EAST DALLAS DENTISTRY PLLC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 5429 E GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75223-1914
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Country | US
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Telephone | 214-377-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 11627 S LOUISVILLE AVE
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City | TULSA
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State | OK
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Zip | 74137-8543
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Country | US
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Telephone | 918-695-7616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN MASSEEH EMAMI
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Credential | DDS
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Telephone | 918-695-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 33767
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License Number State | TX
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