Provider Demographics
NPI:1497158745
Name:NW DRIVE DENTAL, PLLC
Entity Type:Organization
Organization Name:NW DRIVE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:SARABJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-512-0285
Mailing Address - Street 1:15110 DALLAS PKWY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12185 NEW WORLD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6396
Practice Address - Country:US
Practice Address - Phone:915-493-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty