MEDICARE: PS DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023703428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PS DENTAL PLLC

Provider Business Mailing Address
First Line	:	2300 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1638
Country	:	US
Telephone Number	:	972-525-5150
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAJVIR SINGH
Credential	:	DMD
Telephone Number	:	469-809-1919

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	05/10/2023

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