Provider Demographics
NPI:1497354179
Name:PERLA DENTAL OF KELLER PA
Entity Type:Organization
Organization Name:PERLA DENTAL OF KELLER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
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:469-387-3332
Mailing Address - Street 1:3700 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3806
Mailing Address - Country:US
Mailing Address - Phone:469-387-3332
Mailing Address - Fax:
Practice Address - Street 1:5325 GOLDEN TRIANGLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4469
Practice Address - Country:US
Practice Address - Phone:972-228-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty