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Organization
RADIANT FAMILY DENTAL PLLC
Active
Organization
RADIANT FAMILY DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR YOUSUF DDS (PRESIDENT)
(504) 237-3558
Entity
Organization
Contact information
Practice address
2012 SOUTHLAKE GLEN DR., SOUTHLAKE, TX 76092
(504) 237-3558
Mailing address
2012 SOUTHLAKE GLEN DR., SOUTHLAKE, TX 76092
(504) 237-3558
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023371945
—
TX
Enumeration date
05/08/2018
Last updated
05/08/2018
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