MEDICARE: SA DENTAL OF DALLAS, PLLC

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

General Provider Information

NPI Number	:	1285978379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SA DENTAL OF DALLAS, PLLC

Provider Business Mailing Address
First Line	:	4235 W NORTHWEST HWY
Second Line	:	SUITE 600
City	:	DALLAS
State	:	TX
Zip	:	75220-5047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 W NORTHWEST HWY
Second Line	:	SUITE 600
City	:	DALLAS
State	:	TX
Zip	:	75220-5047
Country	:	US
Telephone Number	:	469-854-6220
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. SULMAN AHMED
Credential	:	DMD
Telephone Number	:	972-361-0600

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	12/17/2012

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