MEDICARE: TRESTLES 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	24716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720379522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRESTLES DENTAL PLLC

Provider Business Mailing Address
First Line	:	3044 OLD DENTON RD STE 126
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5099
Country	:	US
Telephone Number	:	214-549-2273
Fax Number	:	817-531-2389

Provider Business Practice Location Address
First Line	:	3044 OLD DENTON RD STE 126
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5099
Country	:	US
Telephone Number	:	214-549-2273
Fax Number	:	817-531-2389

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ALEXANDER MOLAYEM
Credential	:	DDS
Telephone Number	:	310-927-9012

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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Directions to “TRESTLES DENTAL PLLC ” Practice Location

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