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General NPI Number Information
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NPI Number | 1942084900
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Entity Type | Organization
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Legal Business Name | ST DENTAL PLLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1012 SOUTH CROWLEY RD SUITE A
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City | CROWLEY
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State | TX
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Zip | 76036
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Country | US
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Telephone | 972-772-3402
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Fax | 469-966-4909
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Provider Business Mailing Address
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Address Line | 1503 ROYAL LANE
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City | COLLEYVILLE
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State | TX
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Zip | 76034
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Country | US
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Telephone | 817-899-5397
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Fax | 469-966-4909
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Authorized Official
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Title or Position | PRACTICE OWNER/PEDIATRIC DENTIST
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Name | MS. SABA TAREEN
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Credential | DR DMD
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Telephone | 817-899-5397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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