Provider Demographics
NPI:1033810460
Name:MEKHAEL, NADER SAMIR
Entity type:Individual
Prefix:
First Name:NADER
Middle Name:SAMIR
Last Name:MEKHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 DUCK CREEK DR APT 7206
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7839
Mailing Address - Country:US
Mailing Address - Phone:714-369-7185
Mailing Address - Fax:
Practice Address - Street 1:1705 N TOWN EAST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4140
Practice Address - Country:US
Practice Address - Phone:214-210-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX41085122300000X, 1223G0001X
NC133371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice