Provider Demographics
NPI:1073898268
Name:MAGIC DENTAL, PA
Entity Type:Organization
Organization Name:MAGIC DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-801-9500
Mailing Address - Street 1:1930 E PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-4744
Mailing Address - Country:US
Mailing Address - Phone:817-801-9500
Mailing Address - Fax:817-801-9501
Practice Address - Street 1:1930 E PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4744
Practice Address - Country:US
Practice Address - Phone:817-801-9500
Practice Address - Fax:817-801-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090805505Medicaid