Provider Demographics
NPI:1164655098
Name:PARADISE DENTAL PA
Entity Type:Organization
Organization Name:PARADISE DENTAL PA
Other - Org Name:NADIA TAIYARI, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIYARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-837-2929
Mailing Address - Street 1:2028 HWY 121 SUITE 300
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454
Mailing Address - Country:US
Mailing Address - Phone:972-837-2929
Mailing Address - Fax:972-837-2920
Practice Address - Street 1:2028 HWY 121
Practice Address - Street 2:SUITE 300
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-0000
Practice Address - Country:US
Practice Address - Phone:972-837-2929
Practice Address - Fax:972-837-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty