Provider Demographics
NPI:1457631137
Name:MASID1 PLLC
Entity Type:Organization
Organization Name:MASID1 PLLC
Other - Org Name:SMILE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDRISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-257-8815
Mailing Address - Street 1:16215 NORTH FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-5524
Mailing Address - Country:US
Mailing Address - Phone:281-444-0030
Mailing Address - Fax:281-444-0036
Practice Address - Street 1:16215 NORTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-5524
Practice Address - Country:US
Practice Address - Phone:281-444-0030
Practice Address - Fax:281-444-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17900302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization