MEDICARE: PERLA DENTAL OF ARLINGTON PA

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	21330	TX

General Provider Information

NPI Number	:	1376769125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERLA DENTAL OF ARLINGTON PA

Provider Business Mailing Address
First Line	:	1827 E PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4638
Country	:	US
Telephone Number	:	817-275-4322
Fax Number	:	817-275-1469

Provider Business Practice Location Address
First Line	:	1827 E PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4638
Country	:	US
Telephone Number	:	817-275-4322
Fax Number	:	817-275-1469

Authorized Official
Title or Position	:	OWNER
Name	:	JAYESHA HUSSAIN
Credential	:
Telephone Number	:	817-275-4322

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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