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NPI Code Detail

MEDICARE: PERLA DENTAL OF SOUTH DALLAS

MEDICARE: PERLA DENTAL OF SOUTH DALLAS
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
11223G0001XGeneral Practice Dentistry21330TX

General Provider Information

NPI Number : 1083937767
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERLA DENTAL OF SOUTH DALLAS
Provider Business Mailing Address
First Line : 1801 LANTANA CT
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-3571
Country : US
Telephone Number : 469-387-3332
Fax Number :
Provider Business Practice Location Address
First Line : 7125 S POLK ST
Second Line :
City : DALLAS
State : TX
Zip : 75232-3829
Country : US
Telephone Number : 469-387-3332
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JAYESHA HUSSAIN
Credential : DDS
Telephone Number : 469-387-3332
Provider Enumeration Date : 03/09/2010
Last Update Date : 03/09/2010

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Directions to “PERLA DENTAL OF SOUTH DALLAS ” Practice Location

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