Provider Demographics
NPI:1275096133
Name:ISMAIL, NADIA MAZEN (DDS)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:MAZEN
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 MARILEE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1240
Mailing Address - Country:US
Mailing Address - Phone:619-549-6253
Mailing Address - Fax:
Practice Address - Street 1:1650 W IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7259
Practice Address - Country:US
Practice Address - Phone:469-903-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104763122300000X
TX354501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist