Provider Demographics
NPI:1639574064
Name:UPTOWN DENTAL SOLUTIONS
Entity Type:Organization
Organization Name:UPTOWN DENTAL SOLUTIONS
Other - Org Name:LAKESIDE DENTAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIRUTE-PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-412-0014
Mailing Address - Street 1:6617 HERITAGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8750
Mailing Address - Country:US
Mailing Address - Phone:972-412-0014
Mailing Address - Fax:
Practice Address - Street 1:6617 HERITAGE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8750
Practice Address - Country:US
Practice Address - Phone:972-412-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15087261QD0000X
TX29058261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental