Provider Demographics
NPI:1295325587
Name:GENERAL DENTISTRY MANAGEMENT ONE LLC
Entity type:Organization
Organization Name:GENERAL DENTISTRY MANAGEMENT ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-496-0164
Mailing Address - Street 1:4880 N PRESIDENT GEORGE BUSH HWY # H102
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2742
Mailing Address - Country:US
Mailing Address - Phone:469-209-6982
Mailing Address - Fax:469-754-0084
Practice Address - Street 1:609 W 15TH ST STE 130
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8862
Practice Address - Country:US
Practice Address - Phone:972-423-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty