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General NPI Number Information
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NPI Number | 1902418395
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Entity Type | Individual
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Provider Name | NIDA IMRAN SULEMAN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1010 W AUDIE MURPHY PKWY
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City | FARMERSVILLE
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State | TX
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Zip | 75442-2523
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Country | US
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Telephone | 972-784-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 811 S CENTRAL EXPY STE 232
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City | RICHARDSON
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State | TX
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Zip | 75080-7423
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Country | US
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Telephone | 214-289-6312
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Fax |
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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 | 36478
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License Number State | TX
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