Provider Demographics
NPI:1568625317
Name:NEIGHBORHOOD DENTAL
Entity Type:Organization
Organization Name:NEIGHBORHOOD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMADREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHANY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-712-9595
Mailing Address - Street 1:6803 PRESTON RD
Mailing Address - Street 2:UNIT 122
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5823
Mailing Address - Country:US
Mailing Address - Phone:972-712-9595
Mailing Address - Fax:972-712-9594
Practice Address - Street 1:6803 PRESTON RD
Practice Address - Street 2:UNIT 122
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5823
Practice Address - Country:US
Practice Address - Phone:972-712-9595
Practice Address - Fax:972-712-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22430261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175645405Medicaid