MEDICARE: KANABAR ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		TX

General Provider Information

NPI Number	:	1194991513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANABAR ORTHODONTICS

Provider Business Mailing Address
First Line	:	9669 N CENTRAL EXPY
Second Line	:	SUITE 105
City	:	DALLAS
State	:	TX
Zip	:	75231-5053
Country	:	US
Telephone Number	:	214-692-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	9669 N CENTRAL EXPY
Second Line	:	SUITE 105
City	:	DALLAS
State	:	TX
Zip	:	75231-5053
Country	:	US
Telephone Number	:	214-692-5688
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSHIKA KANABAR
Credential	:	DDS MS
Telephone Number	:	469-693-9517

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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Directions to “KANABAR ORTHODONTICS ” Practice Location

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