MEDICARE: DR. ALY ASSAD SERGIE DDS

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	23444	TX

General Provider Information

NPI Number	:	1205033271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALY ASSAD SERGIE DDS

Provider Business Mailing Address
First Line	:	2717 HOWELL ST STE D
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1137
Country	:	US
Telephone Number	:	214-242-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 HOWELL ST STE D
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1137
Country	:	US
Telephone Number	:	214-242-0960
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	12/02/2013

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