Provider Demographics
NPI:1003280371
Name:LOYAL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LOYAL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVIDAN NEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-529-2404
Mailing Address - Street 1:301 LAS COLINAS BLVD W
Mailing Address - Street 2:# 404
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5477
Mailing Address - Country:US
Mailing Address - Phone:313-529-2404
Mailing Address - Fax:
Practice Address - Street 1:1021 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3070
Practice Address - Country:US
Practice Address - Phone:972-264-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27429261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental