Provider Demographics
NPI:1316595168
Name:DR. MOIZ MOHAMMED ABDUL PLLC
Entity Type:Organization
Organization Name:DR. MOIZ MOHAMMED ABDUL PLLC
Other - Org Name:WYLIE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-706-7057
Mailing Address - Street 1:2014 N HIGHWAY 78 STE 150
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6091
Mailing Address - Country:US
Mailing Address - Phone:972-442-6879
Mailing Address - Fax:972-429-7923
Practice Address - Street 1:2014 N HIGHWAY 78 STE 150
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6091
Practice Address - Country:US
Practice Address - Phone:972-442-6879
Practice Address - Fax:972-429-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty