Provider Demographics
NPI:1265847222
Name:ABUSADA, DARA (DDS)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:ABUSADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 LACY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6514
Mailing Address - Country:US
Mailing Address - Phone:972-869-3789
Mailing Address - Fax:
Practice Address - Street 1:2402 RICE BLVD
Practice Address - Street 2:C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3203
Practice Address - Country:US
Practice Address - Phone:281-833-0101
Practice Address - Fax:281-833-0102
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300131223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice