Provider Demographics
NPI:1265954150
Name:SUPREME DENTAL CARE PLLC
Entity type:Organization
Organization Name:SUPREME DENTAL CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARWEESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-483-0779
Mailing Address - Street 1:5100 W SUBLETT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-4860
Mailing Address - Country:US
Mailing Address - Phone:817-483-0779
Mailing Address - Fax:
Practice Address - Street 1:5100 W SUBLETT RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-4860
Practice Address - Country:US
Practice Address - Phone:817-483-0779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28768261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235570292OtherNPI