Provider Demographics
NPI:1255961843
Name:ALBATROSS 46 LLC
Entity type:Organization
Organization Name:ALBATROSS 46 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIRUTE-PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:817-229-0930
Mailing Address - Street 1:4231 SIGMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4471
Mailing Address - Country:US
Mailing Address - Phone:972-233-5447
Mailing Address - Fax:
Practice Address - Street 1:4231 SIGMA RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4471
Practice Address - Country:US
Practice Address - Phone:972-233-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental