MEDICARE: CASA DENTAL

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	18184	TX

General Provider Information

NPI Number	:	1235495201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA DENTAL

Provider Business Mailing Address
First Line	:	2912 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6218
Country	:	US
Telephone Number	:	214-352-2272
Fax Number	:	214-352-2279

Provider Business Practice Location Address
First Line	:	2912 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6218
Country	:	US
Telephone Number	:	214-352-2272
Fax Number	:	214-352-2279

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. MAJID MIRBAHEDDIN
Credential	:	D.D.S
Telephone Number	:	214-352-2272

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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Directions to “CASA DENTAL ” Practice Location

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