Provider Demographics
NPI:1790490837
Name:ALASSAF DENTAL PLLC
Entity Type:Organization
Organization Name:ALASSAF DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALASSAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-444-6813
Mailing Address - Street 1:5720 MOUNTAIN STREAM TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5165
Mailing Address - Country:US
Mailing Address - Phone:682-444-6813
Mailing Address - Fax:
Practice Address - Street 1:9716 BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3301
Practice Address - Country:US
Practice Address - Phone:682-444-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty