MEDICARE: LAURA G TAIMAN DDS 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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1528520863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA G TAIMAN DDS PLLC

Provider Business Mailing Address
First Line	:	6139 MEADOW RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5058
Country	:	US
Telephone Number	:	469-776-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 PRESTON RD STE 480
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1224
Country	:	US
Telephone Number	:	469-577-1587
Fax Number	:	469-577-1585

Authorized Official
Title or Position	:	DENTIST/ OWNER
Name	:	DR. LAURA GIULIANA TAIMAN
Credential	:	DMD
Telephone Number	:	469-577-1587

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/04/2019

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