MEDICARE: JAVAIRIA IDRIS

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	122300000X	Dentist	42625	TX

General Provider Information

NPI Number	:	1720774789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVAIRIA IDRIS

Provider Business Mailing Address
First Line	:	14891 PRESTON RD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14891 PRESTON RD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7870
Country	:	US
Telephone Number	:	972-661-2766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	07/01/2026

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Directions to “ JAVAIRIA IDRIS ” Practice Location

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