Provider Demographics
NPI:1942609516
Name:ISMAIL DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:ISMAIL DENTAL GROUP, PLLC
Other - Org Name:DENTAL DISTINCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HADIA
Authorized Official - Middle Name:ESSAM
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-226-9941
Mailing Address - Street 1:2007 HUNTCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4724
Mailing Address - Country:US
Mailing Address - Phone:469-226-9941
Mailing Address - Fax:
Practice Address - Street 1:3455 N BELT LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7860
Practice Address - Country:US
Practice Address - Phone:469-226-9941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281661223G0001X
TX241931223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty