Provider Demographics
NPI:1215209929
Name:1ST CLASS DENTISTRY AND ORTHODONTICS PA
Entity Type:Organization
Organization Name:1ST CLASS DENTISTRY AND ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:AJLOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-251-9333
Mailing Address - Street 1:5437 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-1914
Mailing Address - Country:US
Mailing Address - Phone:214-821-4726
Mailing Address - Fax:
Practice Address - Street 1:5437 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-1914
Practice Address - Country:US
Practice Address - Phone:214-821-4726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty