Organization
GRAND PRAIRIE MARVEL DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY OZA (DENTIST)
(201) 744-0760
Entity
Organization
Contact information
Practice address
5020 S HWY 360, SUITE 200, GRAND PRAIRIE, TX 75052
(817) 933-3883
Mailing address
2401 CABRILLO LN, MANSFIELD, TX 76063-4117
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28081
—
TX
Enumeration date
01/11/2018
Last updated
01/11/2018
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