Provider Demographics
NPI:1710439815
Name:DOMINION 1 DENTAL DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:DOMINION 1 DENTAL DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:ADEL
Authorized Official - Last Name:ELSAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-901-8319
Mailing Address - Street 1:801 W PARK ROW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-784-7888
Mailing Address - Fax:
Practice Address - Street 1:801 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3904
Practice Address - Country:US
Practice Address - Phone:817-784-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19153261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental