Organization
IDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOSSAIN DEZHAM (DENTIST/ OWNER)
(916) 716-8311
Entity
Organization
Contact information
Practice address
14902 PRESTON RD, 401, DALLAS, TX 75254-9191
(916) 425-4172
Mailing address
14205 HUGHES LN, DALLAS, TX 75254-8655
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187702903
—
TX
Enumeration date
12/12/2014
Last updated
09/20/2016
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