Provider Demographics
NPI:1649744293
Name:PRIME ORAL WELLNESS &DENTISTRY PLLC
Entity Type:Organization
Organization Name:PRIME ORAL WELLNESS &DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINAXI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-885-9191
Mailing Address - Street 1:3821 LONG PRAIRIE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1599
Mailing Address - Country:US
Mailing Address - Phone:972-885-9191
Mailing Address - Fax:
Practice Address - Street 1:3821 LONG PRAIRIE RD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1599
Practice Address - Country:US
Practice Address - Phone:972-885-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty