Provider Demographics
NPI:1083962104
Name:DYER DENTAL CARE PLLC
Entity Type:Organization
Organization Name:DYER DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIM
Authorized Official - Middle Name:NAGHIBI
Authorized Official - Last Name:RAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-759-7000
Mailing Address - Street 1:10039 DYER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4136
Mailing Address - Country:US
Mailing Address - Phone:915-759-7000
Mailing Address - Fax:888-681-2812
Practice Address - Street 1:10039 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4136
Practice Address - Country:US
Practice Address - Phone:915-759-7000
Practice Address - Fax:888-681-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26272261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental