Provider Demographics
NPI:1386868313
Name:PERLA DENTAL PA
Entity Type:Organization
Organization Name:PERLA DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-602-2000
Mailing Address - Street 1:817 W PIONEER PKWY
Mailing Address - Street 2:STE.150
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4710
Mailing Address - Country:US
Mailing Address - Phone:972-602-2000
Mailing Address - Fax:972-602-2062
Practice Address - Street 1:817 W PIONEER PKWY
Practice Address - Street 2:STE.150
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4710
Practice Address - Country:US
Practice Address - Phone:972-602-2000
Practice Address - Fax:972-602-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty