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General NPI Number Information
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NPI Number | 1922333814
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Entity Type | Organization
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Legal Business Name | NORTH DALLAS ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 915 W EXCHANGE PKWY SUITE 210
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City | ALLEN
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State | TX
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Zip | 75013-7017
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Country | US
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Telephone | 214-383-3883
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Fax | 214-383-9043
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Provider Business Mailing Address
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Address Line | 915 W EXCHANGE PKWY SUITE 210
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City | ALLEN
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State | TX
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Zip | 75013-7017
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Country | US
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Telephone | 214-383-3883
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Fax | 214-383-9043
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Authorized Official
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Title or Position | OWNER
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Name | DR. AFSHIN REZVANI
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Credential | DDS, MD
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Telephone | 214-383-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22161
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License Number State | TX
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