Provider Demographics
NPI:1942569561
Name:MODERN TEXAS DENTAL SPECIALTIES
Entity Type:Organization
Organization Name:MODERN TEXAS DENTAL SPECIALTIES
Other - Org Name:TEXAS ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:214-483-3660
Mailing Address - Street 1:2840 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4829
Mailing Address - Country:US
Mailing Address - Phone:214-483-3660
Mailing Address - Fax:214-483-3577
Practice Address - Street 1:2840 KELLER SPRINGS RD
Practice Address - Street 2:SUITE 703
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4829
Practice Address - Country:US
Practice Address - Phone:214-483-3660
Practice Address - Fax:214-483-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25600261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental