Provider Demographics
NPI:1992395420
Name:SHAHID DENTAL GROUP MT. PLEASANT, PLLC
Entity Type:Organization
Organization Name:SHAHID DENTAL GROUP MT. PLEASANT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUINEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-750-6897
Mailing Address - Street 1:204 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2320
Mailing Address - Country:US
Mailing Address - Phone:903-572-4141
Mailing Address - Fax:
Practice Address - Street 1:204 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2320
Practice Address - Country:US
Practice Address - Phone:903-572-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental