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General NPI Number Information
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NPI Number | 1942569561
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Entity Type | Organization
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Legal Business Name | MODERN TEXAS DENTAL SPECIALTIES
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 2840 KELLER SPRINGS RD SUITE 703
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City | CARROLLTON
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State | TX
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Zip | 75006-4829
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Country | US
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Telephone | 214-483-3660
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Fax | 214-483-3577
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Provider Business Mailing Address
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Address Line | 2840 KELLER SPRINGS RD SUITE 703
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City | CARROLLTON
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State | TX
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Zip | 75006-4829
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Country | US
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Telephone | 214-483-3660
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Fax | 214-483-3577
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHEEB JAOUNI
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Credential | DDS, MS
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Telephone | 214-483-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 25600
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License Number State | TX
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