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General NPI Number Information
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NPI Number | 1962752766
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Entity Type | Organization
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Legal Business Name | STAFFORD FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 9550 FOREST LN SUITE700
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City | DALLAS
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State | TX
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Zip | 75243-5905
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Country | US
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Telephone | 214-341-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 9550 FOREST LN SUITE700
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City | DALLAS
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State | TX
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Zip | 75243-5905
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Country | US
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Telephone | 214-341-7875
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. SAOSAT MARIA OLATUNBOSUN
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Credential | DDS
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Telephone | 225-772-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23931
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License Number State | TX
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