Provider Demographics
NPI:1942646575
Name:BELTLINE SMILE CENTER, PC
Entity Type:Organization
Organization Name:BELTLINE SMILE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYADA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-688-4772
Mailing Address - Street 1:1614 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6309
Mailing Address - Country:US
Mailing Address - Phone:469-688-4772
Mailing Address - Fax:
Practice Address - Street 1:1614 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6309
Practice Address - Country:US
Practice Address - Phone:469-688-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22981305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189148305Medicaid