MEDICARE: NADER SAMIR MEKHAEL

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	41085	TX
3	1223G0001X	General Practice Dentistry	13337	NC
4	1223G0001X	General Practice Dentistry	41085	TX

General Provider Information

NPI Number	:	1033810460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADER SAMIR MEKHAEL

Provider Business Mailing Address
First Line	:	6206 DUCK CREEK DR APT 7206
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-7839
Country	:	US
Telephone Number	:	714-369-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 N TOWN EAST BLVD STE 100
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-4140
Country	:	US
Telephone Number	:	214-210-2327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	10/30/2024

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