Provider Demographics
NPI:1780186205
Name:EAST DALLAS DENTISTRY PLLC
Entity Type:Organization
Organization Name:EAST DALLAS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MASSEEH
Authorized Official - Last Name:EMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-695-7616
Mailing Address - Street 1:11627 S LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8543
Mailing Address - Country:US
Mailing Address - Phone:918-695-7616
Mailing Address - Fax:
Practice Address - Street 1:5429 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-1914
Practice Address - Country:US
Practice Address - Phone:214-377-7312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337671223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty