Provider Demographics
NPI:1467650747
Name:DARDANO, MAURICIO (DMD)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:DARDANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 FOREST OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-8712
Mailing Address - Country:US
Mailing Address - Phone:214-403-5869
Mailing Address - Fax:214-599-8897
Practice Address - Street 1:2401 S STEMMONS FWY STE 1258
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-2321
Practice Address - Country:US
Practice Address - Phone:214-221-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice