Individual
EZANA KIDANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5400 PRESTON OAKS RD, DALLAS, TX 75254-8400
(720) 671-8942
Mailing address
5400 PRESTON OAKS RD, DALLAS, TX 75254-8400
(720) 671-8942
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
47512838
TX
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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