Provider Demographics
NPI:1922333814
Name:NORTH DALLAS ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTH DALLAS ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REZVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:214-383-3883
Mailing Address - Street 1:915 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7017
Mailing Address - Country:US
Mailing Address - Phone:214-383-3883
Mailing Address - Fax:214-383-9043
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-383-3883
Practice Address - Fax:214-383-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty