Provider Demographics
NPI:1376956052
Name:FUSION ORTHODONTICS AND CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:FUSION ORTHODONTICS AND CHILDREN'S DENTISTRY
Other - Org Name:FUSION CHILDREN'S DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMSC, MBA
Authorized Official - Phone:972-666-4949
Mailing Address - Street 1:19200 PRESTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2450
Mailing Address - Country:US
Mailing Address - Phone:972-666-4949
Mailing Address - Fax:972-666-4944
Practice Address - Street 1:19200 PRESTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2450
Practice Address - Country:US
Practice Address - Phone:972-666-4949
Practice Address - Fax:972-666-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263981223P0221X
TX271321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty