Organization
VILLAGE DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR FETOUH (OWNER)
(716) 348-9855
Entity
Organization
Contact information
Practice address
4041 W WHEATLAND RD, SUITE 202, DALLAS, TX 75237-4063
(817) 306-1738
(817) 306-7366
Mailing address
4041 W WHEATLAND RD, SUITE 202, DALLAS, TX 75237-4063
(817) 306-1738
(817) 306-7366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30316
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
24314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568871523
—
TX
05
—
1992950042
—
TX
Enumeration date
01/11/2016
Last updated
01/11/2016
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