MEDICARE: NRH 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

General Provider Information

NPI Number	:	1922671080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NRH DENTAL PLLC

Provider Business Mailing Address
First Line	:	5206 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5206 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6689
Country	:	US
Telephone Number	:	871-281-5000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OMAR FETOUH
Credential	:
Telephone Number	:	716-348-9855

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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