Provider Demographics
NPI:1033242946
Name:DAVINCI DENTISTRY
Entity Type:Organization
Organization Name:DAVINCI DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AJLOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-251-9333
Mailing Address - Street 1:100 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6104
Mailing Address - Country:US
Mailing Address - Phone:817-251-9333
Mailing Address - Fax:817-251-9320
Practice Address - Street 1:100 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 146
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6104
Practice Address - Country:US
Practice Address - Phone:817-251-9333
Practice Address - Fax:817-251-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty