Provider Demographics
NPI:1902418395
Name:SULEMAN, NIDA IMRAN
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:IMRAN
Last Name:SULEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S CENTRAL EXPY STE 232
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7423
Mailing Address - Country:US
Mailing Address - Phone:214-289-6312
Mailing Address - Fax:
Practice Address - Street 1:1010 W AUDIE MURPHY PKWY
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2523
Practice Address - Country:US
Practice Address - Phone:972-784-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice