Provider Demographics
NPI:1225141310
Name:ALSMADI, TARIQ (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:ALSMADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 SAIHAAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:817-793-8515
Mailing Address - Fax:
Practice Address - Street 1:1107 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2515
Practice Address - Country:US
Practice Address - Phone:817-277-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161869601Medicaid
TXG60212-01OtherCHIP ID
TX010389OtherCOMP BENEFITS FACILITY #
TX88D371OtherBLUE CROSS BLUE SHEILD ID
TX1565571OtherUNITED CONCORDIA ID