MEDICARE: PERLA DENTAL OF EAST 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1316242118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERLA DENTAL OF EAST DALLAS

Provider Business Mailing Address
First Line	:	8550 PLANO RD
Second Line	:	SUITE 103
City	:	DALLAS
State	:	TX
Zip	:	75238-4829
Country	:	US
Telephone Number	:	469-387-3332
Fax Number	:	972-223-9600

Provider Business Practice Location Address
First Line	:	8550 PLANO RD
Second Line	:	SUITE 103
City	:	DALLAS
State	:	TX
Zip	:	75238-4829
Country	:	US
Telephone Number	:	469-387-3332
Fax Number	:	972-223-9600

Authorized Official
Title or Position	:	OWNER
Name	:	JAYESHA HUSSAIN
Credential	:	DDS
Telephone Number	:	469-387-3332

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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