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General NPI Number Information
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NPI Number | 1932388089
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Entity Type | Organization
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Legal Business Name | IRWIN K ORNISH DDS MS INC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 11661 PRESTON RD #106
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 214-373-9400
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Fax | 214-373-9419
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Provider Business Mailing Address
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Address Line | 11661 PRESTON RD #106
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 214-373-9400
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Fax | 214-373-9419
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Authorized Official
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Title or Position | ORTHODONTIST PRESIDENT
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Name | DR. IRWIN K ORNISH
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Credential | DDS MS
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Telephone | 214-373-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7112
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License Number State | TX
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