Provider Demographics
NPI:1437497112
Name:MISSION DENTAL PLLC
Entity Type:Organization
Organization Name:MISSION DENTAL PLLC
Other - Org Name:MISSION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARRABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-529-8151
Mailing Address - Street 1:117 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2909
Mailing Address - Country:US
Mailing Address - Phone:817-529-8151
Mailing Address - Fax:817-529-8156
Practice Address - Street 1:117 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2909
Practice Address - Country:US
Practice Address - Phone:817-529-8151
Practice Address - Fax:817-529-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24133122300000X
TX21527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193443222Medicaid
TX193443220Medicaid
TX193743218Medicaid
TX193443219Medicaid
TX193443224Medicaid
TX193443221Medicaid
TX193443223Medicaid