Provider Demographics
NPI:1356838981
Name:FIREWHEEL PEDIATRIC DENTAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:FIREWHEEL PEDIATRIC DENTAL SPECIALISTS PLLC
Other - Org Name:FIREWHEEL PEDIATRIC DENTAL SPECIALISTS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:469-702-0286
Mailing Address - Street 1:4880 N PRESIDENT GEORGE BUSH HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2742
Mailing Address - Country:US
Mailing Address - Phone:972-364-7472
Mailing Address - Fax:
Practice Address - Street 1:4880 N PRESIDENT GEORGE BUSH HWY STE 104
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-364-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid