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General NPI Number Information
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NPI Number | 1881929552
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Entity Type | Individual
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Provider Name | RAJEEV MISRA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 840 SIMMONS COURT
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-909-1023
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Fax | 817-488-9685
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Provider Business Mailing Address
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Address Line | 2140 E. SOUTHLAKE BLVD SUITE L-509
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-909-1023
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Fax | 817-488-9685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17859
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License Number State | TX
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