Provider Demographics
NPI:1164864708
Name:COWBOYS DENTAL
Entity Type:Organization
Organization Name:COWBOYS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRBAHAEDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-242-6020
Mailing Address - Street 1:1725 S IH 35
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7417
Mailing Address - Country:US
Mailing Address - Phone:972-242-6020
Mailing Address - Fax:972-242-6549
Practice Address - Street 1:1725 S IH 35
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-7417
Practice Address - Country:US
Practice Address - Phone:972-242-6020
Practice Address - Fax:972-242-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty