Provider Demographics
NPI:1184933400
Name:GRAND DENTAL PA
Entity type:Organization
Organization Name:GRAND DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:AJLOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-995-0806
Mailing Address - Street 1:850 DALMALLEY LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7931
Mailing Address - Country:US
Mailing Address - Phone:214-821-4726
Mailing Address - Fax:
Practice Address - Street 1:5437 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-1914
Practice Address - Country:US
Practice Address - Phone:214-821-4726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental