Provider Demographics
NPI:1114500121
Name:IRVING DENTAL CARE PC
Entity Type:Organization
Organization Name:IRVING DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-383-1074
Mailing Address - Street 1:1451 W AIRPORT FWY STE 103
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6223
Mailing Address - Country:US
Mailing Address - Phone:817-676-1590
Mailing Address - Fax:817-977-1110
Practice Address - Street 1:1451 W AIRPORT FWY STE 103
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6223
Practice Address - Country:US
Practice Address - Phone:817-676-1590
Practice Address - Fax:817-977-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty