MEDICARE: ORA DENTAL 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	28155	TX

General Provider Information

NPI Number	:	1326552126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORA DENTAL PLLC

Provider Business Mailing Address
First Line	:	7430 N BEACH ST STE 312
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 N BEACH ST STE 312
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:	214-437-9518
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	NASIM SALIM
Credential	:	DDS
Telephone Number	:	214-437-9518

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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