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Organization
MY TEETH DENTAL ORTHODONTICS PLLC
Active
Organization
MY TEETH DENTAL ORTHODONTICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR FETOUH (CEO)
(716) 348-9855
Entity
Organization
Contact information
Practice address
2063 TOWN EAST MALL STE 1036, MESQUITE, TX 75150-4118
(716) 348-9855
Mailing address
2063 TOWN EAST MALL STE 1036, MESQUITE, TX 75150-4118
(716) 348-9855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891810263
—
TX
Enumeration date
05/26/2016
Last updated
04/15/2017
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