Provider Demographics
NPI:1346749165
Name:LUCKY TEETH PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:LUCKY TEETH PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-333-9441
Mailing Address - Street 1:11851 FM423
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068
Mailing Address - Country:US
Mailing Address - Phone:972-798-8282
Mailing Address - Fax:972-798-8060
Practice Address - Street 1:11851 FM423
Practice Address - Street 2:SUITE 500
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068
Practice Address - Country:US
Practice Address - Phone:972-798-8282
Practice Address - Fax:972-798-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty