Provider Demographics
NPI:1235455353
Name:AZTECA DENTAL PLLC
Entity Type:Organization
Organization Name:AZTECA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-419-5001
Mailing Address - Street 1:4858 SOUTH FWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-3901
Mailing Address - Country:US
Mailing Address - Phone:817-534-7325
Mailing Address - Fax:817-534-4429
Practice Address - Street 1:4858 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3901
Practice Address - Country:US
Practice Address - Phone:817-534-7325
Practice Address - Fax:817-534-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty